{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T20:32:30Z","timestamp":1787776350346,"version":"build-2784847793"},"reference-count":59,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:p>Prosthesis-patient Mismatch (PPM) is not uncommon with an incidence reported up to 70% after aortic valve (AV) replacement. Severe forms of PPM are less common (up to 20%); PPM can lead to increased short- and long-term morbidity and mortality. It is important to discriminate PPM from other forms of prosthetic valve dysfunction. Sometimes, prosthetic valve degenerative disease may coexist with PPM. Echocardiography plays an important role in the prevention and diagnosis of PPM. Preemptive strategies to prevent PPM include insertion of newer generation prosthetic valves with better hemodynamic characteristics, stentless prosthesis, aortic root enlargement to insert a larger prosthesis, aortic homograft, and transcutaneous AV implantation. We present an illustrative case and review the literature on PPM pertinent to anesthesiologists.<\/jats:p>","DOI":"10.4103\/aca.aca_9_17","type":"journal-article","created":{"date-parts":[[2017,4,6]],"date-time":"2017-04-06T11:15:08Z","timestamp":1491477308000},"page":"234-242","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["Prosthesis-patient Mismatch - What Cardiac Anesthesiologists Need to Know?"],"prefix":"10.4103","volume":"20","author":[{"given":"Kathirvel","family":"Subramaniam","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soheyla","family":"Nazarnia","sequence":"additional","affiliation":[{"name":"Board Certified Cardiac Anesthesiologist, Tabriz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20250528","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":"Rahimtoola","year":"1978","journal-title":"Circulation"},{"key":"R2-20250528","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/s11936-016-0488-0","article-title":"Prosthesis-patient mismatch after aortic valve replacement","volume":"18","author":"Dahou","year":"2016","journal-title":"Curr Treat Options Cardiovasc Med"},{"key":"R3-20250528","doi-asserted-by":"crossref","first-page":"3762","DOI":"10.3760\/cma.j.issn.0366-6999.20131462","article-title":"Impact of prosthesis-patient mismatch on survival after mitral valve replacement: A systematic review","volume":"126","author":"Zhang","year":"2013","journal-title":"Chin Med J (Engl)"},{"key":"R4-20250528","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1161\/01.CIR.56.6.944","article-title":"Left ventricular function before and following aortic valve replacement","volume":"56","author":"Kennedy","year":"1977","journal-title":"Circulation"},{"key":"R5-20250528","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/S0022-5223(19)41265-8","article-title":"Effects of successful, uncomplicated valve replacement on ventricular hypertrophy, volume, and performance in aortic stenosis and in aortic incompetence","volume":"75","author":"Pantely","year":"1978","journal-title":"J Thorac Cardiovasc Surg"},{"key":"R6-20250528","first-page":"81","article-title":"Early and late outcome after reoperation for prosthetic valve dysfunction: Analysis of 549 patients during a 26-year period","volume":"3","author":"Bortolotti","year":"1994","journal-title":"J Heart Valve Dis"},{"key":"R7-20250528","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1053\/euhj.1998.0872","article-title":"Myocardial structure as a determinant of pre- and postoperative ventricular function and long-term prognosis after valve replacement for aortic stenosis","volume":"19","author":"Lund","year":"1998","journal-title":"Eur Heart J"},{"key":"R8-20250528","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.pcad.2014.05.001","article-title":"Echocardiographic assessment of prosthetic heart valves","volume":"57","author":"Blauwet","year":"2014","journal-title":"Prog Cardiovasc Dis"},{"key":"R9-20250528","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1016\/j.echo.2009.07.013","article-title":"Recommendations for evaluation of prosthetic valves with echocardiography and Doppler ultrasound: A report From the American Society of Echocardiography's Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography","volume":"22","author":"Zoghbi","year":"2009","journal-title":"J Am Soc Echocardiogr"},{"key":"R10-20250528","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1016\/j.jcmg.2015.10.026","article-title":"Predictors and outcomes of prosthesis-patient mismatch after aortic valve replacement","volume":"9","author":"Dayan","year":"2016","journal-title":"JACC Cardiovasc Imaging"},{"key":"R11-20250528","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1016\/S0735-1097(00)00859-7","article-title":"Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its prevention","volume":"36","author":"Pibarot","year":"2000","journal-title":"J Am Coll Cardiol"},{"key":"R12-20250528","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":"Kohsaka","year":"2008","journal-title":"J Thorac Cardiovasc Surg"},{"key":"R13-20250528","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/S0894-7317(88)80099-3","article-title":"Simplification of the Doppler continuity equation for calculating stenotic aortic valve area","volume":"1","author":"Otto","year":"1988","journal-title":"J Am Soc Echocardiogr"},{"key":"R14-20250528","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/0002-8703(51)90002-6","article-title":"Hydraulic formula for calculation of the area of the stenotic mitral valve, other cardiac valves, and central circulatory shunts. I","volume":"41","author":"Gorlin","year":"1951","journal-title":"Am Heart J"},{"key":"R15-20250528","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1136\/hrt.35.1.41","article-title":"Natural history of valvular aortic stenosis","volume":"35","author":"Frank","year":"1973","journal-title":"Br Heart J"},{"key":"R16-20250528","first-page":"211","article-title":"Impact of prosthesis-patient mismatch on hemodynamic and symptomatic status, morbidity and mortality after aortic valve replacement with a bioprosthetic heart valve","volume":"7","author":"Pibarot","year":"1998","journal-title":"J Heart Valve Dis"},{"key":"R17-20250528","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1136\/hrt.2006.102764","article-title":"Prediction of valve prosthesis-patient mismatch prior to aortic valve replacement: Which is the best method?","volume":"93","author":"Bleiziffer","year":"2007","journal-title":"Heart"},{"key":"R18-20250528","doi-asserted-by":"crossref","first-page":"3221","DOI":"10.1161\/CIRCULATIONAHA.104.505248","article-title":"Impact of prosthesis-patient size on functional recovery after aortic valve replacement","volume":"111","author":"Koch","year":"2005","journal-title":"Circulation"},{"key":"R19-20250528","doi-asserted-by":"crossref","first-page":"84","DOI":"10.4103\/0971-9784.173025","article-title":"Patient prosthesis mismatch after aortic valve replacement: An Indian perspective","volume":"19","author":"Joshi","year":"2016","journal-title":"Ann Card Anaesth"},{"key":"R20-20250528","first-page":"245","article-title":"Sizing the aortic annulus","volume":"1","author":"Cerillo","year":"2012","journal-title":"Ann Cardiothorac Surg"},{"key":"R21-20250528","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.1007\/s10554-014-0510-0","article-title":"Prosthesis-patient mismatch after transcatheter aortic valve implantation: Impact of 2D-transthoracic echocardiography versus 3D-transesophageal echocardiography","volume":"30","author":"da Silva","year":"2014","journal-title":"Int J Cardiovasc Imaging"},{"key":"R22-20250528","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1136\/heartjnl-2013-304689","article-title":"How to assess aortic annular size before transcatheter aortic valve implantation (TAVI): The role of echocardiography compared with other imaging modalities","volume":"101","author":"Kenny","year":"2015","journal-title":"Heart"},{"key":"R23-20250528","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1093\/ejcts\/ezs064","article-title":"Aortic annulus sizing: Echocardiographic versus computed tomography derived measurements in comparison with direct surgical sizing","volume":"42","author":"Kempfert","year":"2012","journal-title":"Eur J Cardiothorac Surg"},{"key":"R24-20250528","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 replacement","volume":"7","author":"Hern\u00e1ndez-Vaquero","year":"2012","journal-title":"J Cardiothorac Surg"},{"key":"R25-20250528","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1111\/jocs.12265","article-title":"Moderate patient-prosthesis mismatch predicts cardiac events and advanced functional class in young and middle-aged patients undergoing surgery due to severe aortic stenosis","volume":"29","author":"Hernandez-Vaquero","year":"2014","journal-title":"J Card Surg"},{"key":"R26-20250528","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1016\/j.athoracsur.2005.07.084","article-title":"Prosthesis-patient mismatch after aortic valve replacement: Impact of age and body size on late survival","volume":"81","author":"Moon","year":"2006","journal-title":"Ann Thorac Surg"},{"key":"R27-20250528","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.jacc.2008.09.022","article-title":"Impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: Influence of age, obesity, and left ventricular dysfunction","volume":"53","author":"Mohty","year":"2009","journal-title":"J Am Coll Cardiol"},{"key":"R28-20250528","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1016\/j.recesp.2011.05.008","article-title":"Influence of patient-prosthesis mismatch in the octogenarian undergoing surgery for aortic valve replacement due to severe stenosis","volume":"64","author":"Hernandez-Vaquero","year":"2011","journal-title":"Rev Esp Cardiol"},{"key":"R29-20250528","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1016\/j.athoracsur.2013.04.075","article-title":"Aortic valve prosthesis-patient mismatch and long-term outcomes: 19-year single-center experience","volume":"96","author":"Tully","year":"2013","journal-title":"Ann Thorac Surg"},{"key":"R30-20250528","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1510\/icvts.2009.207597","article-title":"Is patient-prosthesis mismatch an independent risk factor for early and mid-term overall mortality in adult patients undergoing aortic valve replacement?","volume":"9","author":"Urso","year":"2009","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"R31-20250528","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.acvd.2014.10.004","article-title":"Aortic prosthesis-patient mismatch in patients with paradoxical low flow severe aortic stenosis: A dreadful combination","volume":"108","author":"Boulogne","year":"2015","journal-title":"Arch Cardiovasc Dis"},{"issue":"11 Suppl 1","key":"R32-20250528","first-page":"S25","article-title":"Prevalence and long-term outcome of aortic prosthesis-patient mismatch in patients with paradoxical low-flow severe aortic stenosis","volume":"130","author":"Mohty","year":"2014","journal-title":"Circulation"},{"key":"R33-20250528","first-page":"107","article-title":"Manufacturer-provided effective orifice area index charts and the prevention of prosthesis-patient mismatch","volume":"21","author":"House","year":"2012","journal-title":"J Heart Valve Dis"},{"key":"R34-20250528","first-page":"530","article-title":"How reliable is an effective orifice area indexed chart?","volume":"18","author":"House","year":"2009","journal-title":"J Heart Valve Dis"},{"key":"R35-20250528","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.1016\/j.athoracsur.2016.01.048","article-title":"Prosthesis-patient mismatch after aortic valve replacement: Effect on long-term survival","volume":"101","author":"Swinkels","year":"2016","journal-title":"Ann Thorac Surg"},{"key":"R36-20250528","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1007\/s11748-013-0243-3","article-title":"Update on aortic valve prosthesis-patient mismatch in Japan","volume":"61","author":"Sakamoto","year":"2013","journal-title":"Gen Thorac Cardiovasc Surg"},{"key":"R37-20250528","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.1093\/eurheartj\/ehs003","article-title":"The impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: A systematic review and meta-analysis of 34 observational studies comprising 27 186 patients with 133 141 patient-years","volume":"33","author":"Head","year":"2012","journal-title":"Eur Heart J"},{"key":"R38-20250528","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":"Blais","year":"2003","journal-title":"Circulation"},{"key":"R39-20250528","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1016\/j.jtcvs.2005.10.028","article-title":"Prosthesis-patient mismatch after aortic valve replacement predominantly affects patients with preexisting left ventricular dysfunction: Effect on survival, freedom from heart failure, and left ventricular mass regression","volume":"131","author":"Ruel","year":"2006","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"1 Suppl","key":"R40-20250528","first-page":"I553","article-title":"Long-term outcomes after valve replacement for low-gradient aortic stenosis: Impact of prosthesis-patient mismatch","volume":"114","author":"Kulik","year":"2006","journal-title":"Circulation"},{"key":"R41-20250528","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1136\/hrt.2005.067363","article-title":"Prosthesis-patient mismatch: Definition, clinical impact, and prevention","volume":"92","author":"Pibarot","year":"2006","journal-title":"Heart"},{"issue":"2 Suppl","key":"R42-20250528","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1111\/j.1540-8191.1994.tb00917.x","article-title":"What is the best bioprosthetic operation for the small aortic root? allograft, autograft, porcine, pericardial? Stented or unstented?","volume":"9","author":"Barratt-Boyes","year":"1994","journal-title":"J Card Surg"},{"key":"R43-20250528","first-page":"516","article-title":"Comprehensive hemodynamic performance and frequency of patient-prosthesis mismatch of the St. Jude Medical Trifecta bioprosthetic aortic valve","volume":"23","author":"Yadlapati","year":"2014","journal-title":"J Heart Valve Dis"},{"key":"R44-20250528","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1093\/ejcts\/ezv411","article-title":"Early haemodynamic performance of a latest generation supra-annular aortic bioprosthesis: Experience from a large single-centre series","volume":"49","author":"Deutsch","year":"2016","journal-title":"Eur J Cardiothorac Surg"},{"key":"R45-20250528","first-page":"316","article-title":"Mid-long-term clinical results and hemodynamic evaluation of aortic valve replacement with 17 mm St. Jude medical regent valve","volume":"44","author":"Liu","year":"2013","journal-title":"Sichuan Da Xue Xue Bao Yi Xue Ban"},{"key":"R46-20250528","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1007\/s00380-012-0306-x","article-title":"Mid-term results of small-sized St. Jude Medical Regent prosthetic valves (21 mm or less) for small aortic annulus","volume":"28","author":"Mizoguchi","year":"2013","journal-title":"Heart Vessels"},{"key":"R47-20250528","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1016\/S0022-5223(94)70144-X","article-title":"Aortic valve replacement with a stentless porcine aortic valve. A six-year experience","volume":"108","author":"David","year":"1994","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"6 Suppl","key":"R48-20250528","doi-asserted-by":"crossref","first-page":"S130","DOI":"10.1016\/S0003-4975(98)01119-9","article-title":"Hemodynamic features of the freestyle aortic bioprosthesis compared with stented bioprosthesis","volume":"66","author":"Dumesnil","year":"1998","journal-title":"Ann Thorac Surg"},{"key":"R49-20250528","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/1749-8090-2-40","article-title":"Effect of surgeon on transprosthetic gradients after aortic valve replacement with freestyle stentless bioprosthesis and its consequences: A follow-up study in 587 patients","volume":"2","author":"Albert","year":"2007","journal-title":"J Cardiothorac Surg"},{"key":"R50-20250528","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/1010-7940(92)90170-3","article-title":"An appraisal of patch enlargement of the small aortic annulus in 33 patients undergoing aortic valve replacement","volume":"6","author":"Nakano","year":"1992","journal-title":"Eur J Cardiothorac Surg"},{"key":"R51-20250528","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.1016\/S0003-4975(97)00127-6","article-title":"Aortic valve replacement with patch enlargement of the aortic annulus","volume":"63","author":"Sommers","year":"1997","journal-title":"Ann Thorac Surg"},{"key":"R52-20250528","first-page":"31","article-title":"Enlargement of the aortic annulus during aortic valve replacement: A review","volume":"23","author":"Bortolotti","year":"2014","journal-title":"J Heart Valve Dis"},{"key":"R53-20250528","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S0003-4975(02)03680-9","article-title":"Routine enlargement of the small aortic root: A preventive strategy to minimize mismatch","volume":"74","author":"Castro","year":"2002","journal-title":"Ann Thorac Surg"},{"key":"R54-20250528","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1016\/j.athoracsur.2013.11.050","article-title":"Aortic root enlargement in octogenarian patients results in less patient-prosthesis mismatch","volume":"97","author":"Penaranda","year":"2014","journal-title":"Ann Thorac Surg"},{"key":"R55-20250528","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 \u2013 A analysis","volume":"64","author":"Pibarot","year":"2014","journal-title":"J Am Coll Cardiol"},{"key":"R56-20250528","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.echo.2010.08.027","article-title":"Left ventricular reverse remodeling in percutaneous and surgical aortic bioprostheses: An echocardiographic study","volume":"24","author":"Giannini","year":"2011","journal-title":"J Am Soc Echocardiogr"},{"key":"R57-20250528","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1016\/j.jcin.2014.10.029","article-title":"Surgical sutureless and transcatheter aortic valves: Hemodynamic performance and clinical outcomes in propensity score-matched high-risk populations with severe aortic stenosis","volume":"8","author":"Kamperidis","year":"2015","journal-title":"JACC Cardiovasc Interv"},{"key":"R58-20250528","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1016\/j.athoracsur.2015.11.048","article-title":"Prosthesis-patient mismatch after transcatheter aortic valve implantation","volume":"101","author":"Takagi","year":"2016","journal-title":"Ann Thorac Surg"},{"key":"R59-20250528","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1007\/s11748-016-0657-9","article-title":"Aortic valve replacement and prosthesis-patient mismatch in the era of trans-catheter aortic valve implantation","volume":"64","author":"Morita","year":"2016","journal-title":"Gen Thorac Cardiovasc Surg"}],"container-title":["Annals of Cardiac Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00660469-201720020-00020","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T20:08:24Z","timestamp":1787774904000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00660469-201720020-00020"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,4]]},"references-count":59,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.4103\/aca.aca_9_17","relation":{},"ISSN":["0971-9784","0974-5181"],"issn-type":[{"value":"0971-9784","type":"print"},{"value":"0974-5181","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,4]]}}}