The impact of prosthesis-patient mismatch

Nowadays, the main indication for valve surgery, in patients with anatomically important aortic valve disease, occurs at the onset of symptoms, given the presumed benefit of reduced morbidity and mortality associated with this procedure in this context.^– Thus, the presence of PPM following surgical implantation of an aortic bioprosthesis interferes in the expected reduction of symptomatology and mortality rates, thus minimizing the benefits that such invasive procedure could bring to the patient. Therefore, we need tools to predict the risk of PPM and thus implement strategies that can prevent such entity. This scenario was evaluated by Otto et al. in the current issue of the Arquivos Brasileiros de Cardiologia.

PPM is defined echocardiographically by an indexed effective orifice area (EOA) ≤ 0.85cm²/m² and considered severe if ≤ 0.65 cm²/m². Since this parameter is indexed by body surface area, individuals with body mass index ≥ 35 kg/m² have lower reference values (≤ 0.70 cm²/m² and ≤ 0.55 cm²/m², respectively) to avoid overestimation of anatomical severity in these patients. Its reported prevalence varies greatly: up to 70% in the case of moderate PPM and 20% in the case of severe PPM.

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