The Incidence and Consequence of Prosthesis-Patient Mismatch After Surgical Aortic Valve Replacement

Fallon and colleagues evaluated patient-prosthesis mismatch (PPM) following isolated aortic valve replacement reported in the STS Adult Cardiac Surgery Database. They found that both moderate and severe PPM were associated with worse outcomes compared to no PPM over the 10-year study period. Readmission for congestive heart failure and aortic valve rereplacement were both more likely in patients with moderate or severe PPM, and overall survival was lower. The incidences of moderate and severe PPM were reduced over the study period, from 60.1% to 46.8% and from 13.8% to 6.2%, respectively. Because of the worse outcomes with even moderate PPM, the authors emphasize that continued efforts to avoid implantation of too small a prosthesis remain necessary.