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Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement
Thomas Levesque1, Hélène Eltchaninoff1, Romain Chabannes1
1Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France.
Background:
Data on the long-term impact of prosthesis-patient mismatch (PPM) on outcomes after transcatheter aortic valve replacement (TAVR) remain sparse. We therefore aimed to investigate the incidence, predictive factors, and long-term prognostic impact of PPM on bioprosthesis durability and mortality.
Methods:
This was a single-centre retrospective study including 2117 patients who underwent TAVR for aortic stenosis from 2002 to 2022. Moderate PPM was defined by indexed effective orifice area (iEOA) > 0.65 and ≤ 0.85 cm2/m2 (> 0.55 and ≤ 0.70 cm2/m2 if BMI ≥ 30 kg/m2) and severe PPM by an iEOA ≤ 0.65 cm2/m2 (≤ 0.55 cm2/m2 If BMI ≥ 30 kg/m2).
Results:
There were 351 patients (16.6%) with PPM, including 39 patients (1.8%) with severe PPM and 312 patients (14.7%) with moderate PPM. The mean follow-up duration was 31.2 ± 26.5 months. Factors independently associated with the occurrence of PPM were body surface area (odds ratio [OR] 3.32, 95% confidence interval [CI] 1.32-8.35; P = 0.01), valve-in-valve TAVR (OR 6.12, 95% CI 2.29-16.08; P < 0.001), small annulus (OR 2.42, 95% CI 1.41-4.07; P = 0.001), and the use of a balloon-expandable valve (OR 4.17, 95% CI 2.17-8.33; P < 0.001). PPM was associated with increased risk of mortality (hazard ratio [HR] 1.3, 95% CI 1.1-1.5, P = 0.004) and valve thrombosis (HR 4.2, 95% CI 1.4-12.6, P = 0.01), and a trend towards increased risk of structural valve deterioration (HR 1.7, 95% CI 0.9-2.9; P = 0.08).
Conclusions:
The results of this study suggest that PPM has a negative long-term impact on outcomes after TAVR. These findings emphasise the importance of preventing PPM.
Insights
Prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) is linked to higher mortality and valve thrombosis. This study highlights the need to prevent PPM for better long-term TAVR outcomes.
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.
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