{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T15:49:08Z","timestamp":1770565748162,"version":"3.49.0"},"reference-count":49,"publisher":"Georg Thieme Verlag KG","issue":"07","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thorac Cardiovasc Surg"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) may affect survival but data are conflicting. It is assessed by relating effective orifice area (EOA) to body surface area (EOAi). EOA is patient-specific as the result of flow-velocity times area at the individual patient's outflow tract levels (LVOTA) divided by trans-prosthetic flow velocity. However, some studies use projected EOAs (i.e., valve size associated EOAs from other patient populations) to assess how PPM affects outcome.<\/jats:p><jats:p>\n          Methods\u2003We analyzed 76 studies addressing hemodynamic outcome and\/or mortality after bioprosthetic AVR.<\/jats:p><jats:p>\n          Results\u2003In 48 studies, projected or measured EOA for calculation of EOAi and PPM assessment was used (of which 25 demonstrated an effect on survival). We identified 28 additional studies providing measured EOA values and the corresponding Bernoulli's pressure gradients after AVR. Despite EOA being a patient-specific parameter, 77% of studies assessing a PPM impact on survival used projected EOAs. The 28 studies are providing measured EOA values and the corresponding Bernoulli's pressure gradients in patients after AVR showed a highly significant, linear relationship between EOA and Bernoulli's gradient. Considering this relationship, it is surprising that relating EOA to body surface area (BSA) (EOAi) is standard but relating pressure gradients to BSA is not.<\/jats:p><jats:p>\n          Conclusion\u2003We conclude that the majority of studies assessing PPM have used false assumptions because EOA is a patient-specific parameter and cannot be transferred to other patients. In addition, the use of EOAi to assess PPM may not be appropriate and could explain the inconsistent relation between PPM and survival in previous studies.<\/jats:p>","DOI":"10.1055\/s-0038-1676814","type":"journal-article","created":{"date-parts":[[2019,1,18]],"date-time":"2019-01-18T08:34:21Z","timestamp":1547800461000},"page":"550-556","source":"Crossref","is-referenced-by-count":14,"title":["Limitations in the Assessment of Prosthesis-Patient Mismatch"],"prefix":"10.1055","volume":"68","author":[{"given":"Paulo A.","family":"Amorim","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Friedrich Schiller University Jena, Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahmoud","family":"Diab","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Friedrich Schiller University Jena, Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario","family":"Walther","sequence":"additional","affiliation":[{"name":"Department of Basic Sciences, University of Applied Sciences Jena, Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gloria","family":"F\u00e4rber","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Friedrich Schiller University Jena, Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Hagendorff","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University Hospital Leipzig, Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert O.","family":"Bonow","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine Chicago, Chicago, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Torsten","family":"Doenst","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Friedrich Schiller University Jena, Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2019,1,4]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1161\/01.CIR.58.1.20","article-title":"The problem of valve prosthesis-patient mismatch","volume":"58","author":"S H Rahimtoola","year":"1978","journal-title":"Circulation"},{"issue":"13","key":"ref2","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1016\/j.jacc.2014.06.1195","article-title":"Incidence and sequelae of prosthesis-patient mismatch in transcatheter versus surgical valve replacement in high-risk patients with severe aortic stenosis: a PARTNER trial cohort\u2013a analysis","volume":"64","author":"P Pibarot","year":"2014","journal-title":"J Am Coll Cardiol"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1111\/joic.12108","article-title":"Valve-in-valve transcatheter aortic valve implantation: the new playground for prosthesis-patient mismatch","volume":"27","author":"G Faerber","year":"2014","journal-title":"J Interv Cardiol"},{"issue":"03","key":"ref4","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/0735-1097(90)90355-S","article-title":"Validation and applications of indexed aortic prosthetic valve areas calculated by Doppler echocardiography","volume":"16","author":"J G Dumesnil","year":"1990","journal-title":"J Am Coll Cardiol"},{"issue":"08","key":"ref5","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1161\/01.CIR.0000085167.67105.32","article-title":"Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacement","volume":"108","author":"C Blais","year":"2003","journal-title":"Circulation"},{"issue":"03","key":"ref6","first-page":"248","article-title":"Patient-prosthesis mismatch in elderly patients undergoing aortic valve replacement: impact on quality of life and survival","volume":"18","author":"S Urso","year":"2009","journal-title":"J Heart Valve Dis"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.ejcts.2006.04.007","article-title":"Patient prosthesis mismatch affects short- and long-term outcomes after aortic valve replacement","volume":"30","author":"T Walther","year":"2006","journal-title":"Eur J Cardiothorac Surg"},{"issue":"05","key":"ref8","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1016\/j.jtcvs.2007.11.032","article-title":"Prosthesis-patient mismatch affects long-term survival after mechanical valve replacement","volume":"135","author":"S Kohsaka","year":"2008","journal-title":"J Thorac Cardiovasc 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years","volume":"89","author":"W R Jamieson","year":"2010","journal-title":"Ann Thorac Surg"},{"issue":"03","key":"ref12","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1016\/j.athoracsur.2010.11.033","article-title":"Defining patient-prosthesis mismatch and its effect on survival in patients with impaired ejection fraction","volume":"91","author":"D A Cotoni","year":"2011","journal-title":"Ann Thorac Surg"},{"issue":"11","key":"ref13","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1136\/hrt.2009.177220","article-title":"Impact of the indexed effective orifice area on mid-term cardiac-related mortality after aortic valve replacement","volume":"96","author":"S Bleiziffer","year":"2010","journal-title":"Heart"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/1749-8090-7-46","article-title":"Impact of patient-prosthesis mismatch on 30-day outcomes in young and middle-aged patients undergoing aortic valve 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and the American Society of Echocardiography","volume":"30","author":"H Baumgartner","year":"2017","journal-title":"J Am Soc Echocardiogr"},{"issue":"02","key":"ref18","first-page":"183","article-title":"Assessment of prosthetic valve hemodynamics by Doppler: lessons from in vitro studies of the St. Jude valve","volume":"2","author":"S S Khan","year":"1993","journal-title":"J Heart Valve Dis"},{"issue":"06","key":"ref19","first-page":"768","article-title":"Perimount pericardial bioprosthesis for aortic calcified stenosis: 18-year experience with 1133 patients","volume":"15","author":"M R Aupart","year":"2006","journal-title":"J Heart Valve Dis"},{"issue":"02","key":"ref20","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1016\/0003-4975(95)00953-1","article-title":"The last generation of pericardial valves in the aortic position: ten-year follow-up in 589 patients","volume":"61","author":"M R Aupart","year":"1996","journal-title":"Ann Thorac 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Botzenhardt","year":"2005","journal-title":"Thorac Cardiovasc Surg"},{"issue":"03","key":"ref24","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1510\/icvts.2006.144196","article-title":"One year hemodynamic performance of the Perimount Magna pericardial xenograft and the Medtronic Mosaic bioprosthesis in the aortic position: a prospective randomized study","volume":"6","author":"M J Dalmau","year":"2007","journal-title":"Interact Cardiovasc Thorac Surg"},{"issue":"01","key":"ref25","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1067\/mtc.2002.121672","article-title":"Late hemodynamic and clinical outcomes of aortic valve replacement with the Carpentier\u2013Edwards Perimount pericardial bioprosthesis","volume":"124","author":"G Dellgren","year":"2002","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"06","key":"ref26","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1093\/ejcts\/ezv411","article-title":"Early haemodynamic performance of a latest 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Surg"},{"issue":"02","key":"ref35","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/S0003-4975(96)01225-8","article-title":"Hemodynamic performance of small aortic valve bioprostheses: is there a difference?","volume":"63","author":"M L McDonald","year":"1997","journal-title":"Ann Thorac Surg"},{"issue":"03","key":"ref36","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1177\/0218492314543654","article-title":"Rigorous patient-prosthesis matching of Perimount Magna aortic bioprosthesis","volume":"23","author":"H Nakamura","year":"2015","journal-title":"Asian Cardiovasc Thorac Ann"},{"issue":"04","key":"ref37","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1093\/icvts\/ivt270","article-title":"St. Jude Medical Trifecta aortic valve perioperative performance in 200 patients","volume":"17","author":"E Permanyer","year":"2013","journal-title":"Interact Cardiovasc Thorac Surg"},{"issue":"01","key":"ref38","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.ejcts.2009.04.073","article-title":"Clinical results of the Medtronic Mosaic porcine bioprosthesis up to 13 years","volume":"37","author":"F C Riess","year":"2010","journal-title":"Eur J Cardiothorac Surg"},{"issue":"03","key":"ref39","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/j.ejcts.2003.12.011","article-title":"Relation between size of prosthesis and valve gradient: comparison of two aortic bioprosthesis","volume":"25","author":"R Seitelberger","year":"2004","journal-title":"Eur J Cardiothorac Surg"},{"issue":"07","key":"ref40","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1007\/s11748-013-0362-x","article-title":"Early outcomes and hemodynamics after implantation of the Trifecta aortic bioprosthesis","volume":"62","author":"H Seo","year":"2014","journal-title":"Gen Thorac Cardiovasc Surg"},{"issue":"06","key":"ref41","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1016\/j.jtcvs.2012.07.105","article-title":"A prospective, randomized comparison of 3 contemporary bioprosthetic aortic valves: should hemodynamic performance influence device selection?","volume":"144","author":"R M Suri","year":"2012","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"02","key":"ref42","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/S0003-4975(00)02210-4","article-title":"Hemodynamic evaluation of 19-mm Carpentier\u2013Edwards pericardial bioprosthesis in aortic position","volume":"71","author":"H Takakura","year":"2001","journal-title":"Ann Thorac Surg"},{"issue":"05","key":"ref43","doi-asserted-by":"crossref","first-page":"1940","DOI":"10.1016\/j.jtcvs.2013.12.051","article-title":"Comparison of early hemodynamic performance of 3 aortic valve bioprostheses","volume":"148","author":"M Ugur","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"S 01","key":"ref44","first-page":"98","article-title":"Prosthesis-patient mismatch: hemodynamic comparison of stented and stentless aortic valves","volume":"11","author":"K L Yun","year":"1999","journal-title":"Semin Thorac Cardiovasc Surg"},{"issue":"13","key":"ref45","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1016\/j.jacc.2012.05.035","article-title":"Valve prosthesis-patient mismatch (VP-PM): a long-term perspective","volume":"60","author":"S A Daneshvar","year":"2012","journal-title":"J Am Coll Cardiol"},{"issue":"06","key":"ref46","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1016\/j.ahj.2007.12.037","article-title":"Impact of valve prosthesis-patient mismatch estimated by echocardiographic-determined effective orifice area on long-term outcome after aortic valve replacement","volume":"155","author":"I Florath","year":"2008","journal-title":"Am Heart 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