Hemodynamic Factors Affecting the Fate of Valvular Bioprosthesis

Abstract

Ce qui est simple est faux mais ce qui ne l’est pas est inutilisable. — —Paul Valery Since their introduction in 1969, valvular bioprostheses (ie, glutaraldehyde-processed animal valves)1 have experienced a surprising increase in use as a result of progress in valve processing2 and growing patient desire for nonthrombogenic valve surgery.3 However, the persistent risk of structural valve deterioration, particularly in the young population, remains a major concern. The 2 main causes of valve failure are valve degeneration and calcification. Among the numerous factors influencing the fate of a bioprosthesis, hemodynamic factors are addressed more rarely than biological factors. In this issue of Circulation , Flameng and colleagues4 add important information to the understanding of how hemodynamic factors play a role in structural valve failure. To do so, they revive an old debate on the practical significance of prosthesis-patient mismatch. First introduced by Rahimtoola in 19785 and having fed numerous discussions for many years, this paradigm led to the simple conclusion that, in aortic valve replacement, the larger the valve is, the better the hemodynamics and therefore the clinical result are. Accordingly, surgeons were advised to carefully measure the aortic valve orifice and to select a valve by fitting the aortic valve orifice in correlation …