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PATIENT-PROSTHESIS MISMATCH IS A PREVENTABLE DISEASE BUT HOW TO PREVENT IT IS A STORY NOT YET WRITTEN
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  • Antonio Calafiore,
  • Antonio Totaro,
  • Stefano Guarracini,
  • Sotirios Prapas,
  • Massimo Di Marco,
  • Kostas katsavrias,
  • Mario Gaudino,
  • Roberto Lorusso,
  • Michele Di Mauro
Antonio Calafiore
Gemelli Molise
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Antonio Totaro
Gemelli Molise
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Stefano Guarracini
Private Hospital Pierangeli Srl
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Sotirios Prapas
Henry Dunant Hospital Center
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Massimo Di Marco
Ospedale Civile dello Spirito Santo
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Kostas katsavrias
Henry Dunant Hospital Center
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Mario Gaudino
NewYork-Presbyterian Hospital/Weill Cornell Medical Center
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Roberto Lorusso
Maastricht UMC+
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Michele Di Mauro
Maastricht UMC+
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Abstract

Large studies demonstrated that moderate or severe patient-prosthesis mismatch (PPM) occurs in 44.2% to 65% of patients undergoing aortic valve replacement. If there is general agreement that patients with PPM have worse outcome than patients without, it is difficult to understand how to prevent this dangerous complication. The formula used to calculate the effective orifice area (EOA) of an implanted aortic prosthesis has many weak points that produce inconsistent results using the same prosthetic valve (type and size). The observed EOA (3 to 6 months postoperatively) of a #23 biological prosthesis can range from 0.9 to 3.5 cm², making PPM prevention impossible using projected EOA, where only the mean value is reported (1.83 cm² for the same #23 biological prosthesis). An EACTS-STS-AATS Valve Labelling Task Force has been established to suggest the manufacturers to present essential information on valvular prosthesis characteristics in standardized Valve Charts. For valves used in the aortic position, Valve Charts should include a standardized PPM chart to assess the probability of PPM after implantation. This will not solve completely the conundrum of prevention, but most likely it will be a step ahead.

Peer review status:ACCEPTED

30 Dec 2020Submitted to Journal of Cardiac Surgery
30 Dec 2020Assigned to Editor
30 Dec 2020Submission Checks Completed
30 Dec 2020Editorial Decision: Accept