In the randomized controlled trial cohort , patients in the small aortic annulus tertile who underwent transcatheter aortic valve replacement had a lower incidence of severe prosthesis-patient mismatch ( 19.7 % versus 37.5 % ; P = 0.03 ) and only a trend toward a higher incidence of moderate-to-severe paravalvular leaks compared with surgical aortic valve replacement ( 5.7 % versus 0 % ; P = 0.06 ) .