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Updated: Oct 11, 2025
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Racial Differences in the Incidence and Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve
Hanbit Park1, Jung-Min Ahn1, Do-Yoon Kang1
1Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Objectives:
The aim of this study was to compare the incidence and prognostic significance of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) according to racial groups.
Background:
PPM after TAVR may be of more concern in Asian populations considering their relatively small annular and valve sizes compared with Western populations.
Methods:
TP-TAVR (Transpacific TAVR Registry) was an international multicenter cohort study of patients with severe aortic stenosis who underwent TAVR in the United States and South Korea from January 2015 to November 2019. PPM was defined as moderate (0.65-0.85 cm2/m2) or severe (<0.65 cm2/m2) at the indexed effective orifice area. The primary outcome was a composite of death, stroke, or rehospitalization at 1 year.
Results:
Among 1,101 eligible patients (533 Asian and 569 non-Asian), the incidence of PPM was significantly lower in the Asian population (33.6%; moderate, 26.5%; severe, 7.1%) than in the non-Asian population (54.5%; moderate, 29.8%; severe, 24.7%). The 1-year rate of the primary outcome was similar between the PPM and non-PPM groups (27.5% vs 28.1%; P = 0.69); this pattern was consistent between Asian (25.4% vs 25.2%; P = 0.31) and non-Asian (28.7% vs 32.1%; P = 0.97) patients. After multivariable adjustment, the risk for the primary outcome did not significantly differ between the PPM and non-PPM groups in the overall population (HR: 0.95; 95% CI: 0.74-1.21), in Asian patients (HR: 1.07; 95% CI: 0.74-1.55), and in non-Asian patients (HR: 0.86; 95% CI: 0.63-1.19).
Conclusions:
In this study of patients with severe aortic stenosis who underwent TAVR, the incidence of PPM was significantly lower in Asian patients than in non-Asian patients. The 1-year risk for the primary composite outcome was similar between the PPM and non-PPM groups regardless of racial group. (Transpacific TAVR Registry [TP-TAVR]; NCT03826264).
Insights
Prosthesis-patient mismatch (PPM) is less common in Asian patients undergoing transcatheter aortic valve replacement (TAVR). The study found no significant difference in 1-year outcomes between patients with or without PPM across racial groups.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Disparities
Background:
- Prosthesis-patient mismatch (PPM) is a concern in transcatheter aortic valve replacement (TAVR), potentially more so in Asian populations due to smaller anatomical sizes.
- Understanding racial differences in PPM incidence and impact is crucial for optimizing TAVR outcomes globally.
Purpose of the Study:
- To compare the incidence of PPM after TAVR between Asian and non-Asian populations.
- To evaluate the prognostic significance of PPM on 1-year clinical outcomes in a diverse TAVR cohort.
Main Methods:
- The Transpacific TAVR Registry (TP-TAVR) included 1,101 patients with severe aortic stenosis undergoing TAVR in the US and South Korea.
- PPM was defined by indexed effective orifice area (moderate: 0.65-0.85 cm²/m²; severe: <0.65 cm²/m²).
- The primary outcome was a composite of death, stroke, or rehospitalization at 1 year.
Main Results:
- The incidence of PPM was significantly lower in Asian patients (33.6%) compared to non-Asian patients (54.5%).
- The 1-year composite outcome rates were similar between PPM and non-PPM groups overall (27.5% vs 28.1%) and within racial subgroups.
- Multivariable analysis showed no significant difference in the risk of the primary outcome based on PPM status, irrespective of race.
Conclusions:
- Asian patients exhibit a lower incidence of PPM following TAVR compared to non-Asian patients.
- PPM does not appear to significantly impact 1-year clinical outcomes after TAVR, regardless of racial background.
