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Long-Term Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement in Patients With Small

Itamar Loewenstein1, Bar Gitter1, Tamar Itach1

  • 1Cardiology Department, Tel Aviv Medical Center, Affiliated With the School of Medicine at Tel Aviv University, Tel Aviv, Israel.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|March 2, 2026
PubMed
Abstract

Insights

Prosthesis-patient mismatch (PPM) is common in transcatheter aortic valve replacement (TAVR) for small aortic annuli (SAA). Significant PPM increases long-term mortality, highlighting the need for careful valve selection in SAA TAVR patients.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Prosthetic Heart Valves

Background:

  • Prosthesis-patient mismatch (PPM) is a frequent complication after transcatheter aortic valve replacement (TAVR).
  • PPM is particularly concerning in patients with small aortic annuli (SAA), potentially leading to worse clinical outcomes.
  • Understanding PPM in SAA TAVR is crucial for optimizing patient management and improving long-term results.

Purpose of the Study:

  • To investigate the incidence, predictors, and long-term clinical impact of PPM in patients undergoing TAVR for SAA.
  • To compare the occurrence and consequences of PPM specifically within the SAA TAVR population.
  • To identify factors associated with PPM and its influence on mortality after SAA TAVR.

Main Methods:

  • Retrospective analysis of 631 consecutive patients with SAA (annulus area ≤ 430 mm²) undergoing transfemoral TAVR.
  • Significant PPM defined as moderate or greater, classified per Valve Academic Research Consortium (VARC)-3 criteria.
  • Inverse probability treatment weighting (IPTW) used to identify predictors of PPM and long-term mortality.

Main Results:

  • Significant PPM occurred in 23.3% of SAA TAVR patients.
  • Predictors of PPM included Bioprosthetic-Embolic Valve (BEV) implantation and larger body surface area (BSA).
  • Significant PPM was independently associated with higher 5-year mortality (HR 1.97) and moderate/above paravalvular leak.

Conclusions:

  • Significant PPM remains highly prevalent in the SAA TAVR population.
  • BEV implantation and larger BSA are associated with increased PPM risk, while larger annulus perimeter shows a protective effect.
  • Significant PPM is an independent predictor of long-term mortality following SAA TAVR.
Keywords:
PPMTAVRballoon‐expandable valvesparavalvular leakprosthesis‐patient mismatchsmall‐aortic annulus

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