JOURNAL CLUB

Thank you for visiting the Journal Club. Please find below the current articles for discussion at the next meeting. For more information about the Journal Club, please contact James Edgerton, MD, at 972-596-6676.

Patient/Prosthesis Mismatch in AVR

Prosthesis size and long-term survival after aortic valve replacement (pdf)

This study was undertaken to quantify the relationship between prosthesis size adjusted for patient size (prosthesis-patient size) and long-term survival after aortic valve replacement.
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The Influence of Patient-Prosthesis Mismatch on In-Hospital Complications and Early Mortality after Aortic Valve Replacement (pdf)

The study aim was to analyze the relationship between patient-prosthesis mismatch (PPM) and in-hospital complications and mortality after aortic valve replacement (AVR). Methods: AVR was performed in 1,819 patients between January 1996 and July 2006. Follow up investigations were performed after a mean of 4.3 years (range: 0 days to 10.6 years). Univariate and multivariate analysis were used to evaluate risk factors for in-hospital complications and mortality in patients with prosthesis mismatch. Actuarial statistics were used to calculate survival rates.
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Impact of Valve Prosthesis-Patient Mismatch on Short-Term Mortality After Aortic Valve Replacement (pdf)

The prosthesis used for aortic valve replacement (AVR) can be too small in relation to body size, thus causing valve prosthesis-patient mismatch (PPM) and abnormally high transvalvular pressure gradients. This study examined if there is a relation between PPM and short-term mortality after operation.
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Impact of Patient-Prosthesis Mismatch and Aortic Valve Design on Coronary Flow Reserve After Aortic Valve Replacement (pdf)

This prospective-randomized study investigated the effect of aortic valve design and patient-prosthesis mismatch (PPM) on coronary flow reserve (CFR) after mechanical or biological aortic valve replacement (AVR) in patients with aortic stenosis (AS).
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Enlargement of the Small Aortic Root During Aortic Valve Replacement: Is There a Benefit? (pdf)

Aortic root enlargement (ARE) at the time of aortic valve replacement (AVR) is an often proposed but still unproven technique to prevent prosthesis-patient mismatch. To evaluate the risks and benefits of ARE, we examined the outcomes of patients with small aortic roots who underwent AVR with or without the use of ARE.
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Survival after valve replacement for aortic stenosis: Implications for decision making (pdf)

Recommendations for aortic valve replacement in severe aortic stenosis are based primarily on the presence of symptoms. However, the onset of symptoms is often insidious, potentially leading to delayed intervention and suboptimal results. Identifying factors that reduce the survival of patients undergoing aortic valve replacement could lead to revised treatment guidelines and improved outcomes.
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Prevention of valve prosthesis-patient mismatch before aortic valve replacement: does it matter and is it feasible? (pdf)

In this issue of Heart, Bleiziffer et al1 present a study evaluating the best method to predict valve prosthesis-patient mismatch (VP-PM) before aortic valve replacement. As they point out, VP-PM remains a controversial issue, and the use of different methods to identify VP-PM might have contributed to the contradictory results reported in previous studies. Their findings are important from two standpoints: (1) they demonstrate that not all methods are equally efficient in this regard and that in fact some approaches that purport to attain this objective are for all practical purposes useless; (2) they further confirm that when the right method is used, VP-PM can be predicted and also largely prevented by using a simple strategy at the time of operation.
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Prosthesis-patient mismatch: definition, clinical impact, and prevention (pdf)

Prosthesis-patient mismatch (PPM) is present when the effective orifice area of the inserted prosthetic valve is too small in relation to body size. Its main haemodynamic consequence is to generate higher than expected gradients through normally functioning prosthetic valves. This review updates the present knowledge about the impact of PPM on clinical outcomes. PPM is common (20% of aortic valve replacements) and has been shown to be associated with worse haemodynamic function, less regression of left ventricular hypertrophy, more cardiac events, and lower survival. Moreover, as opposed to most other risk factors, PPM can largely be prevented by using a prospective strategy at the time of operation.
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