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J Thorac Cardiovasc Surg 2003;126:313-316
© 2003 The American Association for Thoracic Surgery

Editorial

Prosthesis-patient size: measurement and clinical implications

A. Marc Gillinov, MDa,*, Eugene H. Blackstone, MDa,b, Leonardo L. Rodriguez, MDc

a the Departments of Cardiothoracic Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
c Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
b Biostatistics, The Cleveland Clinic Foundation, Cleveland, Ohio, USA

Received for publication September 19, 2002; accepted for publication October 17, 2002.

* Address for reprints: A. Marc Gillinov, MD, Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation/F25, 9500 Euclid Ave, Cleveland, OH 44195 USA.
gillinom@ccf.org

The first 300 words of the full text of this article appear below.

"Mismatch can be considered to be present when the effective prosthetic valve area, after insertion into the patient, is less than that of a normal human valve...occasionally it can be a severe problem because the patient may be hemodynamically and symptomatically worse after valve replacement."

This is the definition of prosthesis-patient mismatch framed by Rahimtoola1 when he coined the term in 1978. Rahimtoola suggested that the degree of prosthesis-patient mismatch could be quantified and that such quantification might aid in identifying patients at risk of clinical sequelae caused by this condition. DeCarlo and colleagues2 seek to undertake these tasks in their report on small-sized Sorin Bicarbon prostheses (Sorin Biomedica, Saluggia, Italy). Although seemingly straightforward, application of Rahimtoola’s definition requires examination and clarification of several complex concepts, including (1) measurement of prosthesis size, (2) measurement of patient size, (3) normalization of these values, (4) selection of referent values, and (5) assessment of the influence of prosthesis-patient size on clinical outcome.

Prosthesis Size

Prosthesis size can be based on either geometric dimensions or functional performance of the prosthesis (Table 1). Geometric expressions of prosthesis size include labeled size and internal orifice size. Functional expressions of prosthesis size include both in vitro and in vivo effective orifice area (EOA).


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  		TABLE 1. Measurements of prosthesis size

 
Although used frequently to assess the effect of prosthesis size on outcome, labeled valve size is limited in this regard.3 Manufacturer’s labeled size refers inconsistently to diameter of the external sewing ring (mechanical prostheses), mounting ring (stented xenografts), or internal orifice (allografts and some stentless xenografts). Furthermore, valves of the same type (mechanical or bioprosthetic) and same labeled size from 2 different manufacturers nearly always have disparate geometric dimensions.3 Given these limitations, labeled valve size is a poor choice for analyzing the effect of prosthesis size on patient outcome. . . . [Full Text of this Article]






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