{"id":5675,"date":"2025-05-12T18:24:17","date_gmt":"2025-05-12T18:24:17","guid":{"rendered":"https:\/\/www.heart-valve-surgery.com\/learning\/?page_id=5675"},"modified":"2025-06-02T19:15:22","modified_gmt":"2025-06-02T19:15:22","slug":"bespoke-procedure-patient-prosthesis-mismatch","status":"publish","type":"page","link":"https:\/\/www.heart-valve-surgery.com\/learning\/bespoke-procedure-patient-prosthesis-mismatch\/","title":{"rendered":"Cardiac Innovation: BeSPoKE Procedure for Patient Prosthesis Mismatch"},"content":{"rendered":"<p>Getting the right-sized valve is imperative for achieving successful outcomes after aortic valve replacement. For that reason, cardiac surgeons go to great lengths to match the patient&#8217;s size with the valve they plan to use for replacement. In many cases, implanting the largest size possible aims to achieve better valve efficiency and make a future TAVR valve-in-valve re-replacement possible. Unfortunately, the replacement valve is sometimes too small, resulting in patient prosthesis mismatch, creating complications like higher pressures and increased workload on the heart.<\/p>\n<p>We receive a lot of questions from patients in our community about patient prosthesis mismatch, especially since many of them are anticipating a second operation for re-replacement. We were thrilled to have <a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-Eric-Roselli-Cleveland-Ohio.php\">Dr. Eric Roselli<\/a> join us to share his insights about he approaches patient prosthesis mismatch with the BeSPoKE procedure, a new innovative technique. Dr. Roselli is the Chief of Cardiac Surgery at the Cleveland Clinic in Cleveland, Ohio, and the primary author of a recently published study on the BeSPoKE Procedure.<\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/7EB5SN3ihQ4?rel=0?si=plM76qlIrRzodTPv\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><\/p>\n<p>&nbsp;<\/p>\n<h2>About Patient Prosthesis Mismatch and the BeSPoKE Procedure<\/h2>\n<p>Here are the key insights shared by Dr. Roselli:<\/p>\n<ul>\n<li>A good match is essential. \u201cI think people get it,\u201d said Dr. Roselli. \u201cYou have a stenotic valve, and they give you a new one that opens it up. But, when we put a valve in somebody, there\u2019s a little bit of hardware in there, and it takes up space. For some people, that space is already small. And so, there has to be a good match, and that\u2019s where this whole mismatch thing comes in.\u201d<\/li>\n<li>Sometimes, the valve wears out or is just too small. \u201cSometimes the valve sort of fits,\u201d said Dr. Roselli. \u201cThe opening may work for a while, but it will take a beating if it\u2019s on the smaller side. It might take up just enough space for the heart to struggle, which can become a serious problem for someone. So, you go in with aortic stenosis, get your valve replaced, feel pretty good for a while, and then the valve can wear out fast, or just never was big enough.\u201d<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-5677 aligncenter\" src=\"https:\/\/www.heart-valve-surgery.com\/learning\/..\/Images\/heart-valve-sizes.jpg\" alt=\"Heart Valve Sizes\" width=\"650\" height=\"362\" \/><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li>Surgeons are getting better at addressing potential mismatch. \u201cFortunately, now there\u2019s a much greater appreciation for this, especially in active young patients,\u201d explained Dr. Roselli. \u201cIt\u2019s important to get a bigger valve, and I think surgeons are doing this. Surgeons are doing things like annular enlargements, so we do that. The space is small, and we don\u2019t want to put a small valve in someone who\u2019s avoided this mismatch. We\u2019ll make that space bigger, and there are a lot of techniques to use. There is a hands-on course here at the STS where surgeons can share their techniques, so I think surgeons are getting better about that.\u201d<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/www.annalsthoracicsurgery.org\/article\/S0003-4975(24)01040-3\/abstract\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-5721 aligncenter\" src=\"https:\/\/www.heart-valve-surgery.com\/learning\/..\/Images\/BeSPoKE-Procedure-Research.jpg\" alt=\"BeSPoKE Procedure\" width=\"654\" height=\"804\" \/><\/a><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li>What is the BeSPoKE Procedure? \u201cWe just <a href=\"https:\/\/www.annalsthoracicsurgery.org\/article\/S0003-4975(24)01040-3\/abstract\">published a novel technique<\/a> for the most severe prosthesis mismatch situations,\u201d said Dr. Roselli. \u201cSomething we call a BeSPoKE Procedure. It\u2019s a combination of a root replacement and a Konno Procedure, where we not only split that opening in the back to make a little more room, but we blow the whole space open. We cut into the muscle or into the right and left ventricle and reconstruct that area. It\u2019s a technique modified from some used in kids with congenital heart disease that we now apply in adults. We\u2019ve had great results in those patients.\u201d<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-5720 aligncenter\" src=\"https:\/\/www.heart-valve-surgery.com\/learning\/..\/Images\/bespoke-procedure-patient-prosthesis-mismatch-eric-roselli.jpg\" alt=\"Bespoke Procedure \" width=\"284\" height=\"427\" \/>BeSPoKE Procedure<\/p>\n<p>&nbsp;<\/p>\n<h2>Thanks Dr. Roselli and the Cleveland Clinic!<\/h2>\n<p>On behalf of all the patients in our community, thank you, <a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-Eric-Roselli-Cleveland-Ohio.php\">Dr. Eric Roselli<\/a>, for everything you and your team are doing at the Cleveland Clinic in Cleveland, Ohio!<\/p>\n<p>Related links:<\/p>\n<ul>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-Eric-Roselli-Cleveland-Ohio.php\">See Dr. Eric Roselli\u2019s Interactive Surgeon Profile<\/a><\/li>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/learning\/shared-decision-making-dr-eric-roselli\/\">Ari\u2019s Patient Success Story: Shared Decision Making with Dr. Roselli<\/a><\/li>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/learning\/aortic-valves-aneurysms-interactions\/\">Surgeon Roundtable: Aortic Valve &amp; Aneurysm Interaction and Treatment<\/a><\/li>\n<\/ul>\n<p>Keep on tickin,<br \/>\nAdam<\/p>\n<p>P.S. For the deaf and hard-of-hearing members of our patient community, we have provided a written transcript of our interview with Dr. Roselli below.<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":4,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"cms.php","meta":{"_acf_changed":false,"footnotes":""},"categories":[11],"class_list":["post-5675","page","type-page","status-publish","hentry","category-medical-technology"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages\/5675","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\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/comments?post=5675"}],"version-history":[{"count":15,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages\/5675\/revisions"}],"predecessor-version":[{"id":5861,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages\/5675\/revisions\/5861"}],"wp:attachment":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/media?parent=5675"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/categories?post=5675"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}