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Prevention of Torsade de Pointes in Hospital Settings
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2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery
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J Am Coll Cardiol, 2000; 36:1131-1141
© 2000 by the American College of Cardiology Foundation
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REVIEW ARTICLE

Hemodynamic and clinical impact of prosthesis–patient mismatch in the aortic valve position and its prevention

Philippe Pibarot, DVM, PhD, FACCa and Jean G. Dumesnil, MD, FRCP(C), FACCa

a Quebec Heart Institute/Laval Hospital, Laval University, Sainte-Foy, Quebec, Canada

Manuscript received July 27, 1999; revised manuscript received March 27, 2000, accepted June 1, 2000.

Reprint requests and correspondence: Dr. Jean G. Dumesnil, Quebec Heart Institute, Laval Hospital, 2725 Chemin Sainte-Foy, Sainte-Foy, Quebec, Canada G1V-4G5
medjgd{at}hermes.ulaval.ca

Prosthesis–patient mismatch is present when the effective orifice area of the inserted prosthetic valve is less than that of a normal human valve. This is a frequent problem in patients undergoing aortic valve replacement, and its main hemodynamic consequence is the generation of high transvalvular gradients through normally functioning prosthetic valves. The purposes of this report are to present an update on the concept of aortic prosthesis–patient mismatch and to review the present knowledge with regard to its impact on hemodynamic status, functional capacity, morbidity and mortality. Also, we propose a simple approach for the prevention and clinical management of this phenomenon because it can be largely avoided if certain simple factors are taken into consideration before the operation.

Abbreviations and Acronyms
  BSA = body surface area
  EOA = effective orifice area
  LV = left ventricular




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 Ann. Thorac. Surg.Home page
Y. Sakamoto, K. Hashimoto, H. Okuyama, H. Takakura, S. Ishii, S. Taguchi, and H. Kagawa
Prevalence and Avoidance of Patient-Prosthesis Mismatch in Aortic Valve Replacement in Small Adults
Ann. Thorac. Surg., April 1, 2006; 81(4): 1305 - 1309.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
C. Blais, I. G. Burwash, G. Mundigler, J. G. Dumesnil, N. Loho, F. Rader, H. Baumgartner, R. S. Beanlands, B. Chayer, L. Kadem, et al.
Projected Valve Area at Normal Flow Rate Improves the Assessment of Stenosis Severity in Patients With Low-Flow, Low-Gradient Aortic Stenosis: The Multicenter TOPAS (Truly or Pseudo-Severe Aortic Stenosis) Study
Circulation, February 7, 2006; 113(5): 711 - 721.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
M. R. Moon, M. K. Pasque, N. A. Munfakh, S. J. Melby, J. S. Lawton, N. Moazami, J. E. Codd, T. D. Crabtree, H. B. Barner, and R. J. Damiano Jr
Prosthesis-Patient Mismatch After Aortic Valve Replacement: Impact of Age and Body Size on Late Survival
Ann. Thorac. Surg., February 1, 2006; 81(2): 481 - 489.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
A. Roscitano, U. Benedetto, A. Sciangula, E. Merico, F. Barberi, R. Bianchini, E. Tonelli, and R. Sinatra
Indexed effective orifice area after mechanical aortic valve replacement does not affect left ventricular mass regression in elderly
Eur. J. Cardiothorac. Surg., February 1, 2006; 29(2): 139 - 143.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
G. Tasca, Z. Mhagna, S. Perotti, P. B. Centurini, T. Sabatini, A. Amaducci, F. Brunelli, M. Cirillo, M. D. Tomba, E. Quiani, et al.
Impact of Prosthesis-Patient Mismatch on Cardiac Events and Midterm Mortality After Aortic Valve Replacement in Patients With Pure Aortic Stenosis
Circulation, January 31, 2006; 113(4): 570 - 576.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
D. Mohty-Echahidi, J. F. Malouf, S. E. Girard, H. V. Schaff, D. E. Grill, M. E. Enriquez-Sarano, and F. A. Miller Jr
Impact of Prosthesis-Patient Mismatch on Long-Term Survival in Patients With Small St Jude Medical Mechanical Prostheses in the Aortic Position
Circulation, January 24, 2006; 113(3): 420 - 426.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
M. A. Borger, S. M. Carson, J. Ivanov, V. Rao, H. E. Scully, C. M. Feindel, and T. E. David
Stentless Aortic Valves are Hemodynamically Superior to Stented Valves During Mid-Term Follow-Up: A Large Retrospective Study
Ann. Thorac. Surg., December 1, 2005; 80(6): 2180 - 2185.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
D. Perez de Arenaza, B. Lees, M. Flather, F. Nugara, T. Husebye, M. Jasinski, M. Cisowski, M. Khan, M. Henein, J. Gaer, et al.
Randomized Comparison of Stentless Versus Stented Valves for Aortic Stenosis: Effects on Left Ventricular Mass
Circulation, October 25, 2005; 112(17): 2696 - 2702.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
W.R. E. Jamieson, L. H. Burr, R. T. Miyagishima, E. Germann, J. S. MacNab, E. Stanford, F. Chan, M. T. Janusz, and H. Ling
Carpentier-Edwards supra-annular aortic porcine bioprosthesis: Clinical performance over 20 years
J. Thorac. Cardiovasc. Surg., October 1, 2005; 130(4): 994 - 1000.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
R. Guenzinger, W. B. Eichinger, F. Botzenhardt, S. Bleiziffer, I. Wagner, R. Bauernschmitt, S. M. Wildhirt, and R. Lange
Rest and Exercise Performance of the Medtronic Advantage Bileaflet Valve in the Aortic Position
Ann. Thorac. Surg., October 1, 2005; 80(4): 1319 - 1326.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
J. Chambers, J. Roxburgh, C. Blauth, J. O'Riordan, F. Hodson, and H. Rimington
A randomized comparison of the MCRI On-X and CarboMedics Top Hat bileaflet mechanical replacement aortic valves: Early postoperative hemodynamic function and clinical events
J. Thorac. Cardiovasc. Surg., September 1, 2005; 130(3): 759 - 764.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
L. F. Duebener, U. Stierle, A. Erasmi, M. F. Bechtel, D. Zurakowski, J. O. Bohm, C. A. Botha, W. Hemmer, J.-G. Rein, H.-H. Sievers, et al.
Ross Procedure and Left Ventricular Mass Regression
Circulation, August 30, 2005; 112(9_suppl): I-415 - I-422.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
F. Botzenhardt, W. B. Eichinger, S. Bleiziffer, R. Guenzinger, I. M. Wagner, R. Bauernschmitt, and R. Lange
Hemodynamic Comparison of Bioprostheses for Complete Supra-Annular Position in Patients With Small Aortic Annulus
J. Am. Coll. Cardiol., June 21, 2005; 45(12): 2054 - 2060.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
C. G. Koch, F. Khandwala, F. G. Estafanous, F. D. Loop, and E. H. Blackstone
Impact of Prosthesis-Patient Size on Functional Recovery After Aortic Valve Replacement
Circulation, June 21, 2005; 111(24): 3221 - 3229.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
A. Penta de Peppo, J. Zeitani, P. Nardi, G. Iaci, P. Polisca, R. De Paulis, and L. Chiariello
Small "Functional" Size after Mechanical Aortic Valve Replacement: No Risk in Young to Middle-Age Patients
Ann. Thorac. Surg., June 1, 2005; 79(6): 1915 - 1920.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
M. Li, J. G. Dumesnil, P. Mathieu, and P. Pibarot
Impact of valve prosthesis-patient mismatch on pulmonary arterial pressure after mitral valve replacement
J. Am. Coll. Cardiol., April 5, 2005; 45(7): 1034 - 1040.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
F. A. Crawford Jr
Residual pulmonary artery hypertension after mitral valve replacement: Size matters!
J. Am. Coll. Cardiol., April 5, 2005; 45(7): 1041 - 1042.
[Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
E. Otero, J. L. Pomar, J. M. Revuelta, and J. J. Rufilanchas
Comparative Evaluation of Small-Size Sorin Slimline and St. Jude HP Heart Valve Prostheses
Ann. Thorac. Surg., April 1, 2005; 79(4): 1284 - 1290.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
G. Tasca, F. Brunelli, M. Cirillo, M. Dalla Tomba, Z. Mhagna, G. Troise, and E. Quaini
Impact of the Improvement of Valve Area Achieved With Aortic Valve Replacement on the Regression of Left Ventricular Hypertrophy in Patients With Pure Aortic Stenosis
Ann. Thorac. Surg., April 1, 2005; 79(4): 1291 - 1296.
[Abstract] [Full Text] [PDF]

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 Am. J. Physiol. Heart Circ. Physiol.Home page
D. Garcia, P. J. C. Barenbrug, P. Pibarot, A. L. A. J. Dekker, F. H. van der Veen, J. G. Maessen, J. G. Dumesnil, and L.-G. Durand
A ventricular-vascular coupling model in presence of aortic stenosis
Am J Physiol Heart Circ Physiol, April 1, 2005; 288(4): H1874 - H1884.
[Abstract] [Full Text] [PDF]

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 Asian Cardiovasc. Thorac. Ann.Home page
P. P Urbanski, W. Dinstak, S. Frank, A. Siebel, and R. W Hacker
Modified versus Standard Mechanical Valved Aortic Conduit
Asian Cardiovasc Thorac Ann, March 1, 2005; 13(1): 53 - 57.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
R. G. Fuster, J. A. M. Argudo, O. G. Albarova, F. H. Sos, S. C. Lopez, M. B. Codoner, J. A. B. Minano, and I. R. Albarran
Patient-prosthesis mismatch in aortic valve replacement: really tolerable?
Eur. J. Cardiothorac. Surg., March 1, 2005; 27(3): 441 - 449.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
G. Tasca, F. Brunelli, M. Cirillo, M. DallaTomba, Z. Mhagna, G. Troise, and E. Quaini
Impact of Valve Prosthesis-Patient Mismatch on Left Ventricular Mass Regression Following Aortic Valve Replacement
Ann. Thorac. Surg., February 1, 2005; 79(2): 505 - 510.
[Abstract] [Full Text] [PDF]

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 HeartHome page
C. Seiler
Management and follow up of prosthetic heart valves
Heart, July 1, 2004; 90(7): 818 - 824.
[Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
T. Bottio, G. Rizzoli, G. Thiene, G. Nesseris, D. Casarotto, and G. Gerosa
Hemodynamic and clinical outcomes with the Biocor valve in the aortic position: An 8-year experience
J. Thorac. Cardiovasc. Surg., June 1, 2004; 127(6): 1616 - 1623.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
J. G. Dumesnil and P. Pibarot
Prosthesis size and prosthesis-patient size are unrelated to prosthesis-patient mismatch
J. Thorac. Cardiovasc. Surg., June 1, 2004; 127(6): 1852 - 1852.
[Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
A. Weerasinghe, M. Yusuf, T. Athanasiou, A. Wood, P. Magee, and R. Uppal
Role of transvalvular gradient in outcome from valve replacement for aortic stenosis
Ann. Thorac. Surg., April 1, 2004; 77(4): 1266 - 1271.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
M. Ruel, F. D. Rubens, R. G. Masters, A. L. Pipe, P. Bedard, P. J. Hendry, B. K. Lam, I. G. Burwash, W. G. Goldstein, M. P. Brais, et al.
Late incidence and predictors of persistent or recurrent heart failure in patients with aortic prosthetic valves
J. Thorac. Cardiovasc. Surg., January 1, 2004; 127(1): 149 - 159.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
J. M. Albes, M. Hartrumpf, V. Rudolph, T. Krempl, E. Huttemann, R. Vollandt, and T. Wahlers
Are mechanical valves with enhanced inner diameter advantageous in the small sized aortic annulus?
Ann. Thorac. Surg., November 1, 2003; 76(5): 1564 - 1570.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
E. H. Blackstone, D. M. Cosgrove, W.R. E. Jamieson, N. J. Birkmeyer, J. H. Lemmer Jr, D. C. Miller, E. G. Butchart, G. Rizzoli, M. Yacoub, and A. Chai
Prosthesis size and long-term survival after aortic valve replacement
J. Thorac. Cardiovasc. Surg., September 1, 2003; 126(3): 783 - 793.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
C. Blais, J. G. Dumesnil, R. Baillot, S. Simard, D. Doyle, and P. Pibarot
Impact of Valve Prosthesis-Patient Mismatch on Short-Term Mortality After Aortic Valve Replacement
Circulation, August 26, 2003; 108(8): 983 - 988.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
P. Pibarot and J. G. Dumesnil
Is the hemodynamic performance of the carpentier-edwards perimount valve really equivalent to that of stentless valves?
Ann. Thorac. Surg., August 1, 2003; 76(2): 656 - 657.
[Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
A. M. Gillinov, E. H. Blackstone, and L. L. Rodriguez
Prosthesis-patient size: measurement and clinical implications
J. Thorac. Cardiovasc. Surg., August 1, 2003; 126(2): 313 - 316.
[Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
M. De Carlo, A. D. Milano, C. Nardi, G. Mecozzi, and U. Bortolotti
Serial Doppler echocardiographic evaluation of small-sized sorin bicarbon prostheses
J. Thorac. Cardiovasc. Surg., August 1, 2003; 126(2): 337 - 343.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
S. H. Rahimtoola
Choice of prosthetic heart valve for adult patients
J. Am. Coll. Cardiol., March 19, 2003; 41(6): 893 - 904.
[Abstract] [Full Text] [PDF]

Home page
 Asian Cardiovasc. Thorac. Ann.Home page
P. Ghosh, M. Djordjevic, R. Schistek, R. Baier, and F. Unger
Does Gender Affect Outcome of Cardiac Surgery in Octogenarians?
Asian Cardiovasc Thorac Ann, March 1, 2003; 11(1): 28 - 32.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
M. Hartrumpf, J. M. Albes, T. Krempl, V. Rudolph, and T. Wahlers
The hemodynamic performance of standard bileaflet valves is impaired by a tilted implantation position
Eur. J. Cardiothorac. Surg., March 1, 2003; 23(3): 283 - 291.
[Abstract] [Full Text] [PDF]


 
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