Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement

Area of Science:

• Cardiology
• Interventional Cardiology
• Prosthetic Valve Research

Background:

• Long-term data on prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) are limited.
• PPM can affect bioprosthesis durability and patient survival post-TAVR.

Purpose of the Study:

• To investigate the incidence and predictors of PPM in TAVR patients.
• To assess the long-term prognostic impact of PPM on mortality and bioprosthesis durability.

Main Methods:

• Retrospective analysis of 2117 patients undergoing TAVR for aortic stenosis (2002-2022).
• PPM defined by indexed effective orifice area (iEOA) criteria, considering body mass index (BMI).

Main Results:

• 16.6% of patients experienced PPM (14.7% moderate, 1.8% severe).
• Predictors of PPM included larger body surface area, valve-in-valve TAVR, small annulus, and balloon-expandable valves.
• PPM was associated with increased mortality (HR 1.3) and valve thrombosis (HR 4.2), with a trend towards structural valve deterioration.

Conclusions:

• PPM negatively impacts long-term outcomes after TAVR, including increased mortality and valve thrombosis.
• Preventing PPM is crucial for improving patient prognosis and bioprosthesis performance following TAVR.