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

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Abstract

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

BSA
body surface area
EOA
effective orifice area
LV
left ventricular

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This work was supported in part by the Medical Research Council of Canada, Ottawa, Ontario; the Heart and Stroke Foundation of Quebec, Montreal, Quebec; and the Fonds pour la Recherche en Santé du Québec, Montreal, Quebec, Canada. Dr. Pibarot is a Research Scholar at the Heart and Stroke Foundation of Canada, Ottawa, Ontario, Canada.