{"id":3751,"date":"2023-09-20T13:49:55","date_gmt":"2023-09-20T13:49:55","guid":{"rendered":"https:\/\/www.heart-valve-surgery.com\/learning\/?page_id=3751"},"modified":"2024-10-22T16:00:39","modified_gmt":"2024-10-22T16:00:39","slug":"patient-prosthesis-mismatch","status":"publish","type":"page","link":"https:\/\/www.heart-valve-surgery.com\/learning\/patient-prosthesis-mismatch\/","title":{"rendered":"Doctor Q&#038;A: How To Avoid Patient Prosthesis Mismatch?"},"content":{"rendered":"<p>We just received an excellent question from Fred about avoiding patient prosthesis mismatch when having an aortic valve replacement. Fred asks, \u201cI need an aortic valve replacement and I have been reading about prosthesis mismatch. What, if anything, can I do to avoid this complication?\u201d<\/p>\n<p>To answer Fred\u2019s question about patient prosthesis mismatch (PPM), we met with <a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-Douglas-Johnston-Chicago-Illinois.php\">Dr. Douglas Johnston<\/a>, Chief of Cardiac Surgery at Northwestern Medicine in Chicago, Illinois, who has performed thousands of heart valve surgeries and successfully treated many patients in our community including Kim Clemens and James Wright.<\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/R7hf_mkfWDo?si=tZDJ67KxEb-gKKYB?rel=0\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>&nbsp;<\/p>\n<h2><strong>Key Learnings About Patient Prothesis Mismatch<\/strong><\/h2>\n<p>Here are important learnings from Dr. Johnston about patient prosthesis mismatch:<\/p>\n<ul>\n<li>Patient Prosthesis Mismatch (PPM) occurs when the inside area of a new surgical valve is too small for the patient in relation to their body size. Like heart valve stenosis, PPM causes increased resistance of blood flowing through the valve.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><picture><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full\" src=\"https:\/\/www.heart-valve-surgery.com\/profileImages\/301_129_151.jpg\" alt=\"Dr Douglas Johnston\" width=\"129\" height=\"151\" \/><\/picture><a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-Douglas-Johnston-Chicago-Illinois.php\">Dr. Douglas Johnston<\/a><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li>Once a valve has been surgically implanted, patients are not necessarily free from future valve problems. Patient prosthesis mismatch can be a complication for patients. Dr. Johnston states, \u201cWe understand the long-term implications of a good operation at the right time versus an okay operation that may have an okay result. But, also downstream consequences. One of those complications is patient prosthesis mismatch.\u201d<\/li>\n<li>A correctly sized valve will enhance blood flow and help prolong the durability of the valve replacement.\u00a0 However, a valve that is too small can cause complications. \u201cIf you have moderate patient prosthesis mismatch, it has implications. One is that your heart may not completely get back to normal after surgery because there is still a little bit of pressure across the valve,\u201d states Dr. Johnston. \u201cWe make it better but not perfect.\u201d<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-3756 aligncenter\" src=\"https:\/\/www.heart-valve-surgery.com\/learning\/..\/Images\/patient-prosthesis-mismatch-complications.jpg\" alt=\"Patient Prosthesis Mismatch Complications\" width=\"650\" height=\"364\" \/><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li>Another implication of PPM is that it can affect the ability for patients to have a second valve procedure in the future if needed. For example, a transcatheter aortic valve replacement (TAVR) can be deployed inside a patient\u2019s surgical valve. This is called a &#8220;valve-in-valve&#8221; procedure. If the initial surgical valve implanted is too small, a TAVR valve-in-valve may not be possible. \u201cThe TAVR is going to be even smaller because we&#8217;re taking up space inside,\u201d Dr. Johnston continued. &#8220;A TAVR implanted in an already small space may severely restrict blood flow through the valve.&#8221;<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full aligncenter\" src=\"https:\/\/www.heart-valve-surgery.com\/Images\/aorta-aortic-root-roselli.jpg\" alt=\"Aortic Root\" width=\"650\" height=\"363\" \/><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li>The annulus is the aortic root\u2019s fibrous ring where the valve base sits. When the diameter of the annulus is small, other surgical strategies are available and need to be considered to create extra space. Fortunately, if the annulus is big, then a large valve can be put in, and there is minimal concern for prosthesis mismatch. Dr. Johnston advises, \u201dThis is a time to take a deep dive with the right surgeon and ask them, \u2018What are you going to do about this? How are you going to get me a valve that is big enough for me?\u2019\u201d<\/li>\n<li>Dr. Johnston gives this important advice to wrap up Fred\u2019s question. \u201cIt has to be a conversation between you and your surgeon. There are a lot of strategies, and they depend on your anatomy. Your team should be prepared and already thinking about this issue.\u201d Dr. Johnston recommends that patients know what that strategy is because it not only impacts your first surgery, but also your future.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h2>Thanks Dr. Johnston and Northwestern Medicine!<\/h2>\n<p>On behalf of our patient community, many thanks to <a href=\"https:\/\/www.nm.org\/doctors\/1790957991\/douglas-ross-johnston-md\">Dr. Douglas Johnston<\/a> for sharing his knowledge and expertise about surgical heart valve replacement and avoiding patient prosthesis mismatch. We also thank <a href=\"https:\/\/www.nm.org\/\">Northwestern Medicine<\/a> for continuing to take great care of heart valve patients!<\/p>\n<p>Related Links:<\/p>\n<ul>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/dr-douglas-johnston.php\">Surgeon Spotlight: Dr. Douglas Johnston<\/a><\/li>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/videos\/lifetime-management\">Live Patient Webinar: Lifetime Management of Heart Valve Disease<\/a><\/li>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/learning\/ozaki-procedure\/\">The Ozaki Procedure: What Should You Know?<\/a><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"cms.php","meta":{"_acf_changed":false,"footnotes":""},"categories":[10],"class_list":["post-3751","page","type-page","status-publish","hentry","category-heart-valve-replacement"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages\/3751","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/comments?post=3751"}],"version-history":[{"count":16,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages\/3751\/revisions"}],"predecessor-version":[{"id":5014,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages\/3751\/revisions\/5014"}],"wp:attachment":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/media?parent=3751"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/categories?post=3751"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}