Response to Letter Regarding Article, “Prosthesis-Patient Mismatch in Bovine Pericardial Aortic Valves: Evaluation Using 3 Different Modalities and Associated Medium-Term Outcomes”

Abstract

We thank House et al1 for a thoughtful critical review of our study.2 To keep the study cohort homogenous, we preselected only patients with normal systolic function who underwent an aortic valve replacement with a pericardial tissue valve. We agree that there is a small likelihood of underestimation of the prevalence of prosthesis–patient mismatch (PPM) in our cohort because of low gradient aortic stenosis and normal systolic function, a group of patients who are challenging to evaluate and manage.3 However, among patients from our cohort undergoing aortic valve replacement for aortic stenosis (79% of the cohort), the average preoperative mean gradient was 43.5 mm Hg, suggesting that the likelihood …