Our Summary

This research paper is about patients who have had their aortic valve replaced either through surgery (SAVR) or a less invasive procedure called Transcatheter Aortic Valve Replacement (TAVR). The main issue discussed is something called Prosthesis-Patient Mismatch (PPM), which happens when the size of the artificial valve doesn’t match the patient’s body, leading to high pressure in the aorta (the main artery).

The researchers looked at various studies from 2000 to 2022 to understand how often PPM occurs after these procedures, and how it affects patients’ health. They found that the results were not very consistent - PPM occurred in anywhere from 8% to 80% of SAVR patients and 24% to 35% of TAVR patients. Furthermore, severe PPM happened in 2% to 9% of patients who had to repeat the SAVR procedure and in 14% to 33% of patients who had to repeat the TAVR procedure. Interestingly, despite a higher rate of PPM, patients who underwent repeated TAVR had better survival rates.

The authors conclude that more careful patient selection for either treatment could help improve the performance of the artificial valve and reduce the risk of PPM. Understanding who is more likely to develop PPM could also improve the safety and effectiveness of these procedures and increase survival rates.

FAQs

  1. What is Prosthesis-Patient Mismatch (PPM) and how does it affect patients’ health after aortic valve replacement?
  2. What were the findings of the research regarding the occurrence of PPM in SAVR and TAVR procedures?
  3. How can the risk of PPM be reduced after aortic valve replacement?

Doctor’s Tip

One helpful tip a doctor might tell a patient about valve replacement is to make sure to follow all post-operative instructions carefully. This includes taking prescribed medications, attending follow-up appointments, and participating in cardiac rehabilitation if recommended. By following these instructions, patients can help ensure the success of their valve replacement procedure and reduce the risk of complications such as PPM.

Suitable For

Patients who are typically recommended valve replacement are those with severe aortic stenosis, which is a narrowing of the aortic valve that restricts blood flow from the heart to the rest of the body. Symptoms of severe aortic stenosis include chest pain, shortness of breath, fatigue, and fainting.

In addition, patients who are at a high risk for complications from traditional open-heart surgery may be recommended for a less invasive TAVR procedure. This includes older patients, those with multiple comorbidities, or those who have previously undergone heart surgery.

Overall, the decision to recommend valve replacement surgery is based on the severity of the patient’s condition, their overall health, and their individual risk factors. It is important for patients to work closely with their healthcare team to determine the best treatment option for their specific situation.

Timeline

Before valve replacement:

  • Patient experiences symptoms such as chest pain, shortness of breath, fatigue, dizziness, and fainting due to aortic valve stenosis or regurgitation.
  • Patient undergoes diagnostic tests such as echocardiogram, cardiac catheterization, and MRI to confirm the need for valve replacement.
  • Patient discusses treatment options with their healthcare provider and decides on either SAVR or TAVR procedure.
  • Patient undergoes preoperative evaluation and preparation for the valve replacement surgery.

After valve replacement:

  • Patient undergoes the SAVR or TAVR procedure to replace the damaged aortic valve.
  • Patient is monitored closely in the hospital for any complications or signs of PPM.
  • Patient undergoes postoperative care, including physical therapy and medications to manage pain and prevent infection.
  • Patient is discharged from the hospital and continues follow-up appointments with their healthcare provider to monitor their recovery and valve function.
  • Patient may experience improved symptoms and quality of life after valve replacement, but may also face the risk of PPM and other complications that require further treatment.

What to Ask Your Doctor

Some questions a patient should ask their doctor about valve replacement, specifically regarding Prosthesis-Patient Mismatch (PPM), include:

  1. What is the likelihood of developing PPM after my valve replacement procedure?
  2. How will you determine if the size of the artificial valve matches my body correctly to avoid PPM?
  3. What are the potential risks and complications associated with PPM, and how will they be monitored and managed post-procedure?
  4. Are there any specific factors or characteristics about me that could increase the risk of PPM?
  5. What are the signs and symptoms of PPM that I should watch out for after the procedure?
  6. How often will I need to follow up with you to check for PPM or any related issues?
  7. If PPM occurs, what treatment options are available to address it and improve my outcome?
  8. How does PPM impact my long-term prognosis and quality of life after valve replacement?
  9. Are there any lifestyle changes or precautions I should take to reduce the risk of PPM or its complications?
  10. Can you provide me with any additional resources or information about PPM and its management that I can review?

Reference

Authors: Alnajar A, Hamad N, Azhar MZ, Mousa Y, Arora Y, Lamelas J. Journal: J Card Surg. 2022 Dec;37(12):5388-5394. doi: 10.1111/jocs.17217. Epub 2022 Nov 15. PMID: 36378858