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This editorial refers to ‘The impact of prosthesis–patient mismatch on long-term survival after aortic valve replacement: a systematic review and meta-analysis of 34 observational studies comprising 27 186 patients with 133 141 patient-years†, by S.T. Head et al. , on page 1518 Since the first description of valve prosthesis–patient mismatch (VP-PM) in 1978,1 the problem has been addressed in a large number of studies that have evaluated its effect on patient outcomes. Data regarding the reduction of long-term survival in those with VP-PM have been conflicting. To resolve this conflict, using pooled estimates, Head et al. have provided a systematic review of 34 selected studies assessing the impact of VP-PM after aortic valve replacement (AVR).2 In these 34 studies, 44.2% of the patients had severe or moderate VP-PM which was associated with an increased incidence of all-cause mortality that was statistically significant; however, the incidence of VP-PM associated with cardiac-related mortality was not statistically significant. In seven of these 34 studies, when both moderate and severe VP-PM were analysed …

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