Prosthesis patient mismatch: myth or reality?
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The term prosthesis patient mismatch (PPM) coined by Rahimtoola in 1978 has become a religion of sorts . There are believers and non-believers, but many, if not most, of the surgeons are on either side for reasons other than scientific evidence. Iqbal et al. have given some insights into this complex problem .
By the current definition of PPM, effective orifice area indexed (EOAI) ≤ 0.65 cm2/m2 is severe and 0.65–0.85cm2/m2 is moderate PPM. The Society of Thoracic Surgeons (STS) database shows that up to two thirds of the patients undergoing aortic valve replacement (AVR) seem to be affected by PPM . In the past, for many years, the valve manufacturers were quoting internal geometric area (IGA) which was a measurement of valve area based on the internal diameter of the prosthesis. IGA, however, grossly overestimates the actual in vivo orifice area and hence does not correlate with the transvalvar pressure gradient (TPG). Effective orifice area (EOA) is derived by the formula...
This work was supported by U.N. Mehta Institute of Cardiology and Research Center itself and received no specific grant from any funding agency, commercial or not-for-profit sectors.
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