A Multi-Institutional Study on the Prevalence and Clinical Impact of Patient-Prosthesis Mismatch in Surgical Aortic Valve Replacement

This multi-institutional study analyzed 10,607 patients who underwent surgical aortic valve replacement between 2002 and 2023 to assess the prevalence, predictors, and outcomes of prosthesis-patient mismatch (PPM). PPM was present in 22 percent of patients at a moderate level (effective orifice area indexed [EOAi] ≤0.85 cm²/m²) and in 2 percent at a severe level (EOAi ≤0.65 cm²/m²), while 76 percent had no PPM. Over the last decade, the prevalence of PPM declined from 31 percent to 18 percent (P < 0.05), coinciding with an increase in average valve size from 23 mm to 24 mm and a rise in annular enlargement procedures from 2.4 percent to 6 percent (both P < .05). PPM was significantly associated with increased 30-day mortality (odds ratio [OR] 1.46; 95 percent CI, 1.13–1.88) and worse long-term survival. Age- and sex-stratified analysis revealed a stronger association between advanced age and PPM risk in women compared to men (odds ratio, 2.31 vs 1.66 for age >74 vs <65 years; both P < .05). In conclusion, while the prevalence of PPM has declined due to technical improvements and evolving patient selection, it remains a significant predictor of adverse outcomes. These findings highlight the importance of tailored surgical strategies, particularly in older female patients.