title: Aortic valve replacement and prosthesis-patient mismatch in the era of trans-catheter aortic valve implantation.
abstract: OBJECTIVE
  The treatment strategy for aortic stenosis (AS) has been changing due to newly developed valvular prostheses and trans-catheter aortic valve implantation (TAVI). To determine the role of new modalities for AS with a small aortic root, papers using the concept of prosthesis-patient mismatch (PPM) were reviewed.
  
  
  METHODS
  First, to determine the cut-off value of the indexed effective orifice area (IEOA) for defining PPM, the studies of surgical aortic valve replacement (SAVR) with a follow-up longer than 5 years and a patient number larger than 500 were reviewed. Second, the papers comparing TAVI and SAVR were reviewed. Furthermore, the prevalence of PPM was reviewed, with the addition of papers on aortic root enlargement, sutureless AVR, and aortic valve reconstruction with autologous pericardium.
  
  
  CONCLUSIONS
  The results of the long-term survival after aortic valve replacement (AVR) have indicated that an IEOA less than 0.65 cm(2)/m(2) should be avoided in all cases, whereas the indications for patients with an IEOA between 065 and 0.85 cm(2)/m(2) should be determined by considering multiple factors. A large body size and younger age have a significantly negative influence on the long-term survival. In Asian population, the prevalence of PPM was low, despite the fact that the size of the aortic annulus was small. The IEOA after TAVI was larger than after surgical AVR in population-matched studies. To evaluate the role of TAVI and other modalities for a small aortic root, studies with a longer follow-up and larger volume are thus warranted.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga City, Saga, 849-8501, Japan. moritash@cc.saga-u.ac.jp.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Morita
mesh_terms: D001011:Aorta / Q000473:pathology; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000473:pathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D010496:Pericardium / Q000637:transplantation; D011475:Prosthesis Failure; D017755:Prosthesis Fitting / Q000379:methods; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome
keywords: Aortic root enlargement: trans-catheter aortic valve implantation; Aortic valve replacement; Patient-prosthesis mismatch; Small aortic root