Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its prevention

Prosthesis-patient mismatch is present when the effective orifice area of t he inserted prosthetic valve is less than that of a normal human valve. Thi s is a frequent problem in patients undergoing aortic valve replacement, an d its main hemodynamic consequence is the generation of high transvalvular gradients through normally functioning prosthetic valves. The purposes of t his report are to present an update on the concept of aortic prosthesis-pat ient 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 factor s are taken into consideration before the operation. (T Am Coil Cardiol 200 0;36:1131-41) (C) 2000 by the American College of Cardiology.