Valve prosthesis-patient mismatch: clinical implications in Japanese patients.

Aortic valve replacement (AVR) improves survival in patients with severe aortic stenosis (AS). Following recent advances in Doppler echocardiography, detailed evaluation of results after AVR is now based not only on the degree of alleviation of symptoms but also the degree of functioning of the prosthetic valve and the heart after surgery. Selection of a prosthetic valve is now viewed as an important factor determining postoperative cardiac function and improvement of patient quality of life (QOL). When dealing with a small aortic annulus, which is often seen in patients with AS, the implanted prosthesis size is particularly important. It has been reported that when a prosthesis too small for the body size was used for AVR, early and long-term operative results were worsened by prosthesis-patient mismatch (PPM). On the other hand, there are many reports of lack of clinical problems following AVR using small sized valves. The latter view appears to be predominant in Japan. When selecting a prosthetic valve for Japanese patients, whose body size is in general small, will avoidance of PPM improve outcome or have no effect on postoperative results?