Vicchio and colleagues [1Vicchio M. Della Corte A. De Santo L.S. et al.Prosthesis-patient mismatch in the elderly: survival, ventricular mass regression, and quality of life.Ann Thorac Surg. 2008; 86: 1791-1798Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar] have published another fine article describing the effect, or more correctly the lack of effect, of prosthesis-patient mismatch in elderly patients who have undergone aortic valve replacement. Although this particular article has some points that make it unique, the broader examination of prosthesis-patient mismatch has been examined and discussed for some time in the cardiac surgery community. There is a large body of evidence on which we can draw conclusions and help guide clinical practice. The majority of published studies indicate, as does this one, that there is no significant clinical effect from the mismatch phenomenon. This seems to be especially true in older patients, a point which is important to consider because we will be treating a great many more such patients with the aging of the population.Prosthesis-patient mismatch can be considered analogous to mild, or even moderate, native aortic stenosis. This condition is often well tolerated by the general and elderly population, and accounts for the findings in this article which shows no detectable clinical or quality-of-life deficit between the patients with and without severe prosthesis-patient mismatch.The alternative to accepting some residual gradient after aortic valve replacement is to perform some type of aortic root enlargement to accommodate a larger valve. In this case, the literature shows that the penalty is a higher perioperative mortality rate. This undeniable fact should be on the mind of every surgeon when confronted with a small aortic root. Certainly for the older patients, a simple, safe, and expeditious operation is most likely to yield a successful outcome. As shown by Vicchio and colleagues [1Vicchio M. Della Corte A. De Santo L.S. et al.Prosthesis-patient mismatch in the elderly: survival, ventricular mass regression, and quality of life.Ann Thorac Surg. 2008; 86: 1791-1798Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar], patients will have improved quality of life, they will not feel or notice the effective orifice area index of the new valve, but they will feel better. Vicchio and colleagues [1Vicchio M. Della Corte A. De Santo L.S. et al.Prosthesis-patient mismatch in the elderly: survival, ventricular mass regression, and quality of life.Ann Thorac Surg. 2008; 86: 1791-1798Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar] have published another fine article describing the effect, or more correctly the lack of effect, of prosthesis-patient mismatch in elderly patients who have undergone aortic valve replacement. Although this particular article has some points that make it unique, the broader examination of prosthesis-patient mismatch has been examined and discussed for some time in the cardiac surgery community. There is a large body of evidence on which we can draw conclusions and help guide clinical practice. The majority of published studies indicate, as does this one, that there is no significant clinical effect from the mismatch phenomenon. This seems to be especially true in older patients, a point which is important to consider because we will be treating a great many more such patients with the aging of the population. Prosthesis-patient mismatch can be considered analogous to mild, or even moderate, native aortic stenosis. This condition is often well tolerated by the general and elderly population, and accounts for the findings in this article which shows no detectable clinical or quality-of-life deficit between the patients with and without severe prosthesis-patient mismatch. The alternative to accepting some residual gradient after aortic valve replacement is to perform some type of aortic root enlargement to accommodate a larger valve. In this case, the literature shows that the penalty is a higher perioperative mortality rate. This undeniable fact should be on the mind of every surgeon when confronted with a small aortic root. Certainly for the older patients, a simple, safe, and expeditious operation is most likely to yield a successful outcome. As shown by Vicchio and colleagues [1Vicchio M. Della Corte A. De Santo L.S. et al.Prosthesis-patient mismatch in the elderly: survival, ventricular mass regression, and quality of life.Ann Thorac Surg. 2008; 86: 1791-1798Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar], patients will have improved quality of life, they will not feel or notice the effective orifice area index of the new valve, but they will feel better. Prosthesis-Patient Mismatch in the Elderly: Survival, Ventricular Mass Regression, and Quality of LifeThe Annals of Thoracic SurgeryVol. 86Issue 6PreviewEvaluation of the impact of prosthesis-patient mismatch (PPM) on long-term outcome and quality of life (QOL) in elderly patients who underwent implantation of small size bileaflet prostheses for aortic stenosis. Full-Text PDF