Enlargement of the narrow aortic root: Fear of what?

Prosthesis-patient mismatch (PPM) associated with aortic valve replacement, especially of aortic stenosis, is a common problem. Severe PPM is known to increase perioperative morbidity and mortality and to negatively affect late survival. Surgical enlargement of the narrow aortic root enlargement (ARE) is now increasingly accepted as a method of facilitating implantation of a larger valve prosthesis, hence decreasing the risk of PPM. There are diagnostic methods and tables that help to predict the risk of this complication and assist in the planning of the surgery. Still, many surgeons are afraid or reluctant to perform ARE because of potential technical complications of a procedure perceived to increase the complexity of the surgery. However, these procedures have been proven safe and effective, and are at the reach of almost any cardiac surgeon, including less experienced ones. In addition, there are modifications to the techniques that make them even simpler and more reproducible.