Prosthesis-Patient Mismatch: Current State of Evidence

Abstract

Purpose of review: Prosthesis-patient mismatch (PPM) remains a significant concern in valve intervention. This review highlights the current evidence surrounding PPM, compares its impact after surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI), and addresses ongoing debates in the literature regarding valve selection, procedural strategies, and future approaches to improve patient outcomes.

Recent findings: Recent evidence highlights that moderate to severe PPM is associated with increased mortality and adverse cardiac events, particularly in younger, active patients and those with smaller aortic annuli. Studies have emphasized the role of optimized prosthesis sizing, advanced imaging modalities, and next-generation valve technologies in mitigating PPM. Additionally, TAVI appears to outperform surgical approaches in reducing severe PPM, particularly in high-risk populations. Despite significant progress, PPM remains a persistent challenge in valve intervention procedures, particularly among patients with smaller aortic annuli and those at risk for suboptimal hemodynamic performance. Addressing this issue requires continued innovation in prosthesis design, including valves with improved hemodynamic profiles and more sizing options. Long-term research is essential to better understand the clinical impact of PPM, evaluate valve durability across various types, and develop strategies to prevent its occurrence.

Keywords: Prosthesis-patient mismatch; Surgical aortic valve replacement; Transcatheter aortic valve implantation.