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Severe Patient-Prosthesis Mismatch: Compelling Entity or an Epiphenomenon of Low Flow?

Originally published Cardiovascular Imaging. 2021;14:e012836


The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.

For Disclosures, see page 788.

Correspondence to: Roxy Senior, MD, DM, Royal Brompton Hospital, London, United Kingdom. Email


  • 1. Head SJ, Mokhles MM, Osnabrugge RL, Pibarot P, Mack MJ, Takkenberg JJ, Bogers AJ, Kappetein AP. 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.Eur Heart J. 2012; 33:1518–1529. doi: 10.1093/eurheartj/ehs003CrossrefMedlineGoogle Scholar
  • 2. Herrmann HC, Daneshvar SA, Fonarow GC, Stebbins A, Vemulapalli S, Desai ND, Malenka DJ, Thourani VH, Rymer J, Kosinski AS. Prosthesis-patient mismatch in patients undergoing transcatheter aortic valve replacement: from the STS/ACC TVT registry.J Am Coll Cardiol. 2018; 72:2701–2711. doi: 10.1016/j.jacc.2018.09.001CrossrefMedlineGoogle Scholar
  • 3. Webb JG, Murdoch DJ, Alu MC, Cheung A, Crowley A, Dvir D, Herrmann HC, Kodali SK, Leipsic J, Miller DC, et al.. 3-year outcomes after valve-in-valve transcatheter aortic valve replacement for degenerated bioprostheses: the PARTNER 2 registry.J Am Coll Cardiol. 2019; 73:2647–2655. doi: 10.1016/j.jacc.2019.03.483CrossrefMedlineGoogle Scholar
  • 4. Okuno T, Khan F, Asami M, Praz F, Heg D, Winkel MG, Lanz J, Huber A, Gräni C, Räber L, et al.. Prosthesis-patient mismatch following transcatheter aortic valve replacement with supra-annular and intra-annular prostheses.JACC Cardiovasc Interv. 2019; 12:2173–2182. doi: 10.1016/j.jcin.2019.07.027CrossrefMedlineGoogle Scholar
  • 5. Abbas AE, Pibarot P, Ke X, Alu MC, Rogers E, Hahn R, Leon MB, Thourani V. Impact of flow on prosthesis patient mismatch following transcatheter and surgical aortic valve replacement.Circ Cardiovasc Imaging. 2021; 14:e012364. doi: 10.1161/CIRCIMAGING.120.012364LinkGoogle Scholar
  • 6. Ternacle J, Guimaraes L, Vincent F, Côté N, Côté M, Lachance D, Clavel M-A, Abbas AE, Pibarot P, Rodés-Cabau J. Reclassification of prosthesis–patient mismatch after transcatheter aortic valve replacement using predicted vs. measured indexed effective orifice area.Eur Heart J Cardiovasc Imaging. 2021; 22:11–20. doi: 10.1093/ehjci/jeaa23CrossrefMedlineGoogle Scholar
  • 7. Firstenberg MS, Abel EE, Papadimos TJ, Tripathi RS. Nonconvective forces: a critical and often ignored component in the echocardiographic assessment of transvalvular pressure gradients.Cardiol Res Pract. 2012; 2012:383217. doi: 10.1155/2012/383217CrossrefMedlineGoogle Scholar
  • 8. Baumgartner H, Stefenelli T, Niederberger J, Schima H, Maurer G. “Overestimation” of catheter gradients by Doppler ultrasound in patients with aortic stenosis: a predictable manifestation of pressure recovery.J Am Coll Cardiol. 1999; 33:1655–1661. doi: 10.1016/s0735-1097(99)00066-2CrossrefMedlineGoogle Scholar
  • 9. Anjan VY, Herrmann HC, Pibarot P, Stewart WJ, Kapadia S, Tuzcu EM, Babaliaros V, Thourani VH, Szeto WY, Bavaria JE, et al.. Evaluation of flow after transcatheter aortic valve replacement in patients with low-flow aortic stenosis: a secondary analysis of the PARTNER randomized clinical trial.JAMA Cardiol. 2016; 1:584–592. doi: 10.1001/jamacardio.2016.0759CrossrefMedlineGoogle Scholar
  • 10. Hahn RT, Leipsic J, Douglas PS, Jaber WA, Weissman NJ, Pibarot P, Blanke P, Oh JK. Comprehensive echocardiographic assessment of normal transcatheter valve function.JACC Cardiovasc Imaging. 2019; 12:25–34. doi: 10.1016/j.jcmg.2018.04.010CrossrefMedlineGoogle Scholar
  • 11. Vamvakidou A, Jin W, Danylenko O, Pradhan J, Li W, West C, Khattar R, Senior R. Impact of pre-intervention transaortic flow rate versus stroke volume index on mortality across the hemodynamic spectrum of severe aortic stenosis: Implications for a new hemodynamic classification of aortic stenosis.JACC Cardiovasc Imaging. 2019; 12:205–206. doi: 10.1016/j.jcmg.2018.11.004CrossrefMedlineGoogle Scholar