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

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

View larger version (23K): [in a new window]   Figure 1 Relations between mean transvalvular pressure gradients and indexed effective orifice areas for aortic bioprostheses studied in vitro in a physiologic pulse duplicator system, assuming a normal cardiac index of 3.0 liter/min per m2 at rest and 10% to 50% increases in stroke volume, as may occur during maximal upright exercise. (Reproduced with permission from Dumesnil and Yoganathan [4].)

View larger version (13K): [in a new window]   Figure 2 Postoperative mean transvalvular gradient (A) and cardiac index (B) as a function of the interval since prosthesis implantation (years) in patients with an indexed effective orifice area, at implantation, of 0.65 cm2/m2 (closed triangle pointing down, n = 5), 0.66 to 0.85 cm2/m2 (closed triangle pointing up, n = 29), 0.86 to 1.05 cm2/m2 (open triangle pointing up, n = 29) and >1.05 cm2/m2 (open triangle pointing down, n = 9). *Significant difference between patients with an indexed valve area 0.85 or >0.85 cm2/m2. Data are expressed as the mean value ± SEM. (Reproduced with permission from Pibarot et al. [6].)

View larger version (20K): [in a new window]   Figure 3 Correlation between mean transvalvular gradient and indexed effective orifice area in patients with a stented bioprosthesis (solid circles, n = 51), a stentless bioprosthesis (open circles, n = 194), an aortic homograft (open triangles, n = 55) or a pulmonary autograft (open boxes, n = 96). Panels A and B show this relation for mean gradient measured at rest in all patients and during maximal exercise in a subgroup of 48 patients, respectively. Several points are overlapped.