| Abstract [eng] |
Patient-prosthesis mismatch (PPM) is a condition where the effective orifice area (EOA) of a prosthetic valve is smaller than expected in comparison to the patient’s body surface area. It can be caused by baseline patient variations, ascertainment bias, and selection bias. Data have been published to classify and standardized definitions and evaluation procedures for PPM following surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). This literature review summarizes the epidemiology, etiology, and clinical impact of PPM after either surgical or transcatheter aortic valve replacement. PPM has a significant impact after SAVR on clinical outcomes, including early mortality, renal failure, stroke, need for inotropes, or prolonged ventilation. It may impede left ventricular mass regression and predispose bioprosthetic valve degeneration and should therefore be avoided during surgery. PPM has been linked to higher surgical mortality and impairment of patients' quality of life postoperatively. Meanwhile, TAVR provides a wider orifice of bioprosthetic valve with better trans-prosthetic hemodynamics. TAVR using the Cribier-Edwards or Edwards Sapien valve was linked to lower trans-prosthetic gradients and greater EOAs early after the procedure, leading to a significant reduction in severe PPM at discharge and midterm (12 months) follow-up. TAVR has a lower prevalence of moderate, severe and overall PPM than SAVR due to its superior hemodynamic function. Despite the available data, more evidence is needed on the impact of PPM on long-term survival after TAVR and SAVR. Therefore, there is a need to conduct high-quality clinical trials in this direction. |
