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(Circulation. 2006;114:e627.)
© 2006 American Heart Association, Inc.

Correspondence

Letter by Bleiziffer et al Regarding Article, "Long-Term Outcomes After Valve Replacement for Low-Gradient Aortic Stenosis: Impact of Prosthesis-Patient Mismatch"

Sabine Bleiziffer, MD; Walter Benno Eichinger, MD; Ruediger Lange, PhD, MD

Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, Germany, bleiziffer@dhm.mhn.de

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

With great interest, we read the article by Kulik and associates¹ identifying patient-prosthesis mismatch (PPM) (defined as an effective orifice area [EOA] index below 0.85 cm²/m²) as an independent predictor of a higher incidence of congestive heart failure and impaired left ventricular mass regression after aortic valve replacement in patients with low-gradient aortic stenosis. In the study by Kulik et al, PPM was assessed by reference tables, although echocardiographic EOA index data were also available.

When analyzing large patient populations to investigate the impact of PPM on clinical outcome, echocardiographic EOA index data are often not available, and the EOA is only estimated by reference tables (based on echo or in vitro data) or by the use of the geometric orifice area, which is a fixed geometric parameter derived from the internal prosthesis diameter. One must be aware that these methods cannot detect all patients with severe or moderate PPM, and there are false-positive and false-negative categorizations. Pibarot et al² demonstrated that the sensitivity and specificity to detect PPM are 73% and 80% when using echocardiographically derived reference tables (as done by Kulik et al¹). Blackstone and associates³ used a geometric orifice area of <1.1 cm²/m² to define "a prosthesis too small for patient size" and found no impact on long-term mortality. The indexed geometric valve area has been shown to be unrelated to hemodynamics or clinical outcomes.⁴

Hence, estimations of PPM based on reference tables and on the geometric orifice area yield . . . [Full Text of this Article]

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