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Sex-Related Differences in Prosthesis-Patient Mismatch Following Aortic Valve Replacement with Perceval Sutureless
Ali Aljalloud1, Yusuf Shieba2, Rashad Zayat1
1Department of Cardiac Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany.
Journal of Cardiovascular Development and Disease
|February 26, 2026
Summary
Women experience higher rates of prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) with the Perceval valve, despite similar clinical outcomes. Anatomical differences contribute to this, suggesting tailored strategies for female patients.
Area of Science:
- Cardiology
- Biomedical Engineering
- Thoracic Surgery
Background:
- Prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) can impede left ventricular recovery, particularly in women due to smaller aortic dimensions.
- The Perceval sutureless valve offers larger effective orifice areas, but its sex-specific PPM outcomes require investigation.
Purpose of the Study:
- To evaluate sex-related differences in PPM incidence, severity, and early impact following Perceval AVR.
Main Methods:
- Retrospective analysis of 139 patients (68 males, 71 females) who underwent Perceval AVR.
- PPM defined by Valve Academic Research Consortium-3 (VARC-3) criteria using indexed effective orifice area (EOAi).
- Stratification by body-mass-index (BMI) and assessment of hemodynamic performance via echocardiography.
Main Results:
- PPM was significantly more frequent in women (74.6%) than men (22.1%).
- In non-obese patients, PPM occurred in 47.9% of females vs. 16.2% of males.
- Females received smaller valves, had lower postoperative EOAi, but showed higher LV ejection fraction.
Conclusions:
- Anatomical sex differences lead to higher PPM rates in women after sutureless AVR, primarily of moderate severity.
- Tailored strategies, including aortic root enlargement and sex-specific EOAi thresholds, may optimize prosthesis selection and outcomes for female patients.
