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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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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]

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 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]

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 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]

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 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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 J. Thorac. Cardiovasc. Surg.Home page
S. Khan and A. Trento
Is it better on top? The triumph of supra-annular valves
J. Thorac. Cardiovasc. Surg., March 1, 2003; 125(90030): S12 - 13.
[Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
N. Vitale, S. C. Clark, A. Ramsden, A. Hasan, C. J. Hilton, and M. P. Holden
Clinical and hemodynamic evaluation of small perimount aortic valves in patients aged 75 years or older
Ann. Thorac. Surg., January 1, 2003; 75(1): 35 - 39.
[Abstract] [Full Text] [PDF]

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 Card Surg AdultHome page
N. D. Desai and G. T. Christakis
Stented Mechanical/Bioprosthetic Aortic Valve Replacement
Card. Surg. Adult, January 1, 2003; 2(2003): 825 - 856.
[Full Text]

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 Ann. Thorac. Surg.Home page
D. S. Bach, M. P. Sakwa, M. Goldbach, M. R. Petracek, R. W. Emery, and F. W. Mohr
Hemodynamics and early clinical performance of the St. Jude Medical Regent mechanical aortic valve
Ann. Thorac. Surg., December 1, 2002; 74(6): 2003 - 2009.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
D. H. Freed, J. W. Tam, M. C. Moon, G. E.J. Harding, E. Ahmad, and E. A. Pascoe
Nineteen-millimeter prosthetic aortic valves allow normalization of left ventricular mass in elderly women
Ann. Thorac. Surg., December 1, 2002; 74(6): 2022 - 2025.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
H. Niinami, S. Aomi, H. Tomioka, K. Nakano, and H. Koyanagi
A comparison of the in vivo performance of the 19-mm St. Jude medical hemodynamic plus and 21-mm standard valve
Ann. Thorac. Surg., October 1, 2002; 74(4): 1120 - 1124.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
I. Laforest, J. G. Dumesnil, M. Briand, P. C. Cartier, and P. Pibarot
Hemodynamic Performance at Rest and During Exercise After Aortic Valve Replacement: Comparison of Pulmonary Autografts Versus Aortic Homografts
Circulation, September 24, 2002; 106(12_suppl_1): I-57 - I-62.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
L. J. Castro, J. M. Arcidi Jr, A. L. Fisher, and V. A. Gaudiani
Routine enlargement of the small aortic root: a preventive strategy to minimize mismatch
Ann. Thorac. Surg., July 1, 2002; 74(1): 31 - 36.
[Abstract] [Full Text] [PDF]


 
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