Early in vivo experience with the hemodynamic plus St. Jude medical heart valves in patients with narrowed aortic annulus

Operative Management – Patient-Prosthesis Mismatch

“…IEOA has been reported as an index that correlates with the severity of PPM [2][3][4][5][6] . In present chapter, mild to moderate PPM is defined as when an IEOA of ≥0.70cm 2 /m 2 and <0.85 cm 2 /m 2 , and severe PPM is defined as when an IEOA of less than 0.69 cm 2 /m 2 .…”

“…In such circumstance, surgery should be restricted to the minimum necessary. The EOA of commercially available prosthetic valves was only 49 -66% that of a normal aortic valve [1][2][3][4][5][6][7][8][9] . PPM patients have significantly higher persistent pressure gradients across the valve prosthesis than patients without significant PPM.…”

“…A small decrease in EOA results in a relatively large increase in the transvalvular pressure gradient. Several reports demonstrated that PPM increases LV workload due to the residual pressure gradient, which prevents regression of LVM and increases operative mortality and valve-related events [1][2][3][4][5][6] . The definition of the threshold degree of severe PPM that must be avoided due to an adverse effect on survival is important.…”

“…However, LV workload remains high after AVR due to persistent PPM, which may increase LVM again during the follow-up period. On the other hand, many studies have been reported that mild to moderate PPM appears to have little or no effect on postoperative recovery of cardiac function, late cardiac events and survival [5][6][7][8][9][10][11][12] . Such degree of PPM may be acceptable in not only elderly patients but also younger patients 7 .…”

“…In general, PPM is considered to be present when an indexed EOA (IEOA) adjusted for body surface area (BSA) is <0.85 cm 2 /m 2 2-4 . Although, many studies have shown that PPM adversely affects survival and postoperative cardiac function [2][3][4] , many studies contradict these findings [5][6][7][8][9][10][11][12] . Thus, there is considerable controversy regarding the effects of PPM on survival and postoperative recovery of cardiac functions.…”