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J Thorac Cardiovasc Surg 2006;131:952-955
© 2006 The American Association for Thoracic Surgery

Editorial

Prosthesis–patient mismatch and clinical outcomes: The evidence continues to accumulate

Québec Heart Institute, Laval Hospital, Sainte-Foy, Quebec, Canada.

Received for publication November 21, 2005; revisions received December 13, 2005; accepted for publication December 16, 2005.

^_* Address for reprints: Jean G. Dumesnil, Québec Heart Institute, Laval Hospital, 2725 Chemin Sainte-Foy, Sainte-Foy, Quebec, Canada G1V-4G5. (Email: medjgd@hemes.ulaval.ca).

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

In this issue of the Journal, Ruel and associates ¹ report that aortic valve prosthesis–patient mismatch (PPM) predominantly affects patients with left ventricular (LV) dysfunction. As they point out, PPM remains a controversial issue. On the one hand, there is indeed an increasing body of evidence suggesting that PPM occurs frequently and has important clinical consequences. ^2-13 To the opposite, some authors have argued that PPM is a rare phenomenon without relevant clinical implications. ^14-19 The article from Ruel and colleagues ¹ brings new evidence from two standpoints: (1) It further documents the impact of PPM on long-term clinical outcomes such as survival, freedom from heart failure, and LV mass regression, whereas there has been a paucity of data in this regard and most studies have been limited to the short or medium term; (2) it adds a new dimension to this type of study in that it examines whether PPM and preoperative LV function interact with regard to their impact on these outcomes.

Definition of PPM

Given the controversy that has surrounded PPM and to put the findings of Ruel and coworkers into proper perspective, it is important to review certain essential elements regarding this concept and its identification. Indeed, the term PPM was first coined in 1978 by Rahimtoola, ²⁰ who defined it as follows: "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." In his original publication, the author insisted that the main consequence of PPM would be to produce higher postoperative gradients resulting in an increased hemodynamic burden for the ventricle, and he actually provided a graph summarizing his vision of the relation between the effective orifice area (EOA) of the prosthesis and postoperative gradients. However, the graph showed no normalization for body size and, . . . [Full Text of this Article]

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