The concept of patient-prosthesis mismatch (PPM) was defined as existing "when the effective prosthetic valve area, after insertion into the patient, is less than that of a normal valve". However, based on the correlation between the mean transvalvular pressure gradient and the corrected effective orifice area (EOA), PPM is currently defined as an EOA corrected by a body surface area (BSA) of 65 years old, while supra-annular implantation of a bioprosthesis was done in patients >or=65 years old

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... with a small aortic annulus. We discuss our present strategy after the introduction of a new high performance prosthesis, since the EOAs are dramatically increased.