What is patient-prosthesis mismatch?
Patient-prosthesis mismatch is present when the effective orifice area (EOA) of the inserted aortic prosthetic valve is too small relative to the patient’s body surface area (BSA). The immediate consequence is the persistence of high transvalvular pressure gradients.1, 2, 4-7 What is the prevalence of patient-prosthesis mismatch? Patient-prosthesis mismatch occurs in 20-71% of aortic valve replacements with 52-71% reported in patient’s receiving stented tissue valves.2, 7 How is patient-prosthesis mismatch defined? Studies show that a strong correlation exists between postoperative pressure gradients and the EOA indexed (EOAI) to a patient’s BSA (see Figure 1). Below an EOAI of 0.85 cm2/m2, the gradient increases significantly. Based on this finding, patient-prosthesis mismatch is defined as an EOAI < 0.85 cm2/m2 1, 2, 4, 7 where EOAI = EOA BSA Figure 1: Indexed effective orifice area at rest (cm2/m2)23 Reference EOA The projected EOAI is easily calculated from the in-vivo EOA for a gi
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