For patients with aortic stenosis (AS) and small annulus, aortic root replacement (RR) and aortic root enlargement (RE) are proven methods to prevent prosthesis-patient mismatch (PPM). Our goal was to compare the results of those two categories of operations. This prospective study used our hospitals’ database of aortic valve replacements from 2021 to 2024. Patients who had aortic stenosis treated with RE or RR were compared. The postoperative results and reoperations were compared. Kaplan–Meier survival estimation and log-rank test were used to compare time-to-event data.

A total of 72 patients had aortic stenosis treated with either RE or RR. Thirty-eight (52%) and 34 (47%) patients underwent RR and RE, respectively. In RR cases, significant postoperative bleeding was noted in 13 patients vs. only 4 patients in RE group (P-value = 0.001). The length of stay did not differ …