A meta-analysis of effects of prosthesis–patient mismatch after aortic valve replacement on late mortality

Abstract

Prosthesis–patient mismatch (PPM) describes a state in which the effective orifice area (EOA) of a normally functioning heart valve prosthesis is too small in relation to the patient's body size, which results in high transvalvular pressure gradients [1]. For aortic valve prostheses, PPM is considered to be severe when the indexed EOA (IEOA) is <0.65cm2/m2 and moderate when this value is 0.65–0.85cm2/m2; and PPM is classed as not clinically significant when the IEOA is >0.85cm2/m2 [2]. Patients with PPM have worse functional class and exercise capacity, reduced regression of left ventricular hypertrophy, inferior recovery of coronary flow reserve, impaired blood coagulation status, and more adverse cardiac events after aortic valve replacement (AVR) compared with patients without PPM [3,4].