Cardiopulmonary Exercise Testing in Patients with 21mm St. Jude Medical Aortic Prosthesis Marco De Carlo MD, Aldo Milano MD, Giuseppe Musumeci MD, Giuseppe Tartarini MD, Ombretta Biadi MD, Marco Benedetti MD, Uberto Bortolotti MD Small-sized prostheses may be associated with high transprosthetic gradients, particularly in patients with a body surface area (BSA) >1.70m2, affecting left ventricular mass regression, symptom improvement and long-term survival. The study aim was to verify the utility of cardiopulmonary exercise testing (CPX) in detecting patient-prosthesis mismatch, and to identify the clinical and echocardiographic data that predict exercise tolerance at CPX in patients with a 21mm St. Jude Medical aortic prosthesis. The results indicate that in these patients CPX allows detection of patient-prosthesis mismatch, in terms of impaired exercise tolerance due to circulatory causes. CPX results can be anticipated on the basis of the patient's BSA, age, effective orifice area index and mean transprosthetic gradient. In these patients technical solutions allowing implantation of a larger prosthesis should be considered whenever an active lifestyle can be anticipated following aortic valve replacement.

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