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J Thorac Cardiovasc Surg 2007;133:1405-1408
© 2007 The American Association for Thoracic Surgery

Editorial

Prosthesis–patient mismatch in the mitral position: Old concept, new evidences

Québec Heart Institute/Laval Hospital Research Center, Laval University, Quebec, Canada.

Received for publication January 9, 2007; accepted for publication January 18, 2007.

^_* Address for reprints: Philippe Pibarot, DVM, PhD, FACC, FAHA, Laval Hospital Research Center, 2725 Chemin Sainte-Foy, Sainte-Foy, Quebec, Canada, G1V-4G5. (Email: philippe.pibarot@med.ulaval.ca).

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

Previous studies have demonstrated that prosthesis–patient mismatch (PPM) is associated with inferior hemodynamics, less regression of left ventricular hypertrophy, more cardiac events, and higher mortality rates after aortic valve replacement.^1-12 However, the hemodynamic and clinical impact of PPM after mitral valve replacement (MVR) are relatively unexplored.^2,13-15 The elegant study presented by Lam and colleagues¹⁶ in this issue of the Journal is indeed one of the first reports to demonstrate that PPM is associated with worse outcome after MVR. The main findings of this study are that (1) the incidence of mitral PPM is much higher than previously believed; (2) it is associated with a 4-fold increase in the risk of congestive heart failure after MVR; and (3) it independently affects postoperative survival.

Mitral PPM is actually not a new concept. In the first report of mitral PPM published in 1981, Rahimtoola and Murphy¹³ described the case of a patient who remained symptomatic and had persistent pulmonary artery hypertension and progressive right-sided failure after MVR. In the early 1990s, Dumesnil and colleagues^2,14 demonstrated the existence of a relationship between the indexed effective orifice area (EOA) and the transvalvular pressure gradient in normally functioning prostheses implanted in the mitral position. These findings are consistent with the concept that PPM occurs when the EOA of the prosthesis is too small in relation to the patient’s body size, resulting in an abnormally high postoperative gradient.^1,17,18 In patients with an aortic prosthesis, previous studies consistently found a strong correlation between the indexed EOA and the postoperative transprosthetic gradients measured at rest or during exercise.^1,17,19,20 However, as first reported by Dumesnil and colleagues in 1990,¹⁴ and confirmed by Li and colleagues in 2005,¹⁵ the correlation between the indexed EOA and the mean transprosthetic pressure gradients is lower in patients with mitral prostheses (r < 0.50) . . . [Full Text of this Article]

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The impact of patient–prosthesis mismatch on late outcomes after mitral valve replacement

Buu-Khanh Lam, Vincent Chan, Paul Hendry, Marc Ruel, Roy Masters, Pierre Bedard, Bill Goldstein, Fraser Rubens, and Thierry Mesana
J. Thorac. Cardiovasc. Surg. 2007 133: 1464-1473. [Abstract] [Full Text] [PDF]

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				P. Totaro and V. Argano Reply to the Editor. J. Thorac. Cardiovasc. Surg., February 1, 2008; 135(2): 465 - 466. [Full Text] [PDF]