Is severe valve prosthesis-patient mismatch (VP-PM) associated with a higher mortality?

Abstract

Two papers in the current issue of the journal questioned whether valve prosthesis-patient mismatch (VP-PM) [1] is associated with an increased mortality and have come to different conclusions. Howell etal.[2]have classified severe VP-PMas prosthetic aortic valve area (PHVA) <0.6 cm 2 /m 2 , which was determined at the time of valve implantation from the manufacturer’s in vitro data. The survival (‘all-cause mortality’) was not significantly different at 3 and 5 years from the ‘reference group’ (PHVA 0.6 cm 2 /m 2 ). Walther et al. [3] have also classified PHVA from the manufacturer’s effective office area. They have classified severe VP-PM as PHVA < 0.65 cm 2 /m 2 and moderate VP-PM as PHVA 0.65—0.85 cm 2 /m 2 . In their study, moderate VP-PM was ‘independently predictive for short-term and long-term mortality’. Three recent studies have documented an increased mortality with VP-PM: