Patient-Prosthesis Mismatch After Surgical Aortic Valve Replacement: Analysis of the PARTNER Trials

Vinod H. Thourani*, Amr E. Abbas, Julien Ternacle, Rebecca T. Hahn, Raj Makkar, Susheel K. Kodali, Isaac George, Samir Kapadia, Lars G. Svensson, Wilson Y. Szeto, Howard C. Herrmann, Gorav Ailawadi, Jonathon Leipsic, Philipp Blanke, John Webb, Wael A. Jaber, Mark Russo, S. Chris Malaisrie, Pradeep Yadav, Marie Annick ClavelOmar K. Khalique, Neil J. Weissman, Pamela Douglas, Jeroen Bax, Abdellaziz Dahou, Ke Xu, Vinayak Bapat, Maria C. Alu, Martin B. Leon, Michael J. Mack, Philippe Pibarot

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Our objective was to compare the impact of patient-prosthesis mismatch (PPM) for 2 years after surgical aortic valve replacement within the prospective, randomized Placement of Aortic Transcatheter Valves (PARTNER) trials. Methods: Surgical aortic valve replacement patients from the PARTNER 1, 2, and 3 trials were included. PPM was classified as moderate (indexed effective orifice area ≤0.85 cm2/m2) or severe (indexed effective orifice area ≤0.65 cm2/m2). The primary endpoint was the composite of all-cause death and heart failure rehospitalization at 2 years. Results: By the predicted PPM method (PPMP), 59.1% had no PPM, 38.8% moderate PPM, and 2.1% severe PPM; whereas by the measured PPM method (PPMM), 42.4% had no PPM, 36.0% moderate, and 21.6% severe. Patients with no PPMP (23.6%) had a lower rate of the primary endpoint compared with patients with moderate (28.2%, P = .03) or severe PPMP (38.8%, P = .02). Using the PPMM method, there was no difference between the no (17.7%) and moderate PPMM groups (21.1%) in the primary outcome (P = .16). However, those with no PPMM or moderate PPMM were improved compared with severe PPMM (27.4%, P < .001 and P = .02, respectively). Conclusions: Severe PPM analyzed by PPMP was only 2.1% for surgical aortic valve replacement patients. The PPMM method overestimated the incidence of severe PPM relative to PPMP, but was also associated with worse outcome. There was higher all-cause mortality in patients with severe PPM, thus surgical techniques to minimize PPM remain critical.

Original languageEnglish (US)
Pages (from-to)1164-1171
Number of pages8
JournalAnnals of Thoracic Surgery
Issue number6
StatePublished - Jun 2024

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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