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Published on: May 21, 2017
Prosthesis-Patient Mismatch in All-Comer Patients Undergoing Newer-Generation Self-Expanding Transcatheter Aortic
Xander Jacquemyn1,2, Takuya Ogami1,2, Irsa Hasan1,2
1UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Summary
Prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) is infrequent with contemporary valves and its incidence is declining. Despite hemodynamic differences, PPM does not impact long-term TAVR outcomes.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Prosthetic Heart Valves
Background:
- Prosthesis-patient mismatch (PPM) following transcatheter aortic valve replacement (TAVR) may influence patient outcomes.
- The incidence and clinical impact of PPM using modern self-expanding valves require further investigation.
Purpose of the Study:
- To determine the frequency, predictors, and long-term clinical outcomes of PPM in a real-world TAVR population.
- To analyze PPM trends over time in patients receiving contemporary self-expanding TAVR devices.
Main Methods:
- Analysis of a prospectively maintained institutional database (2017-2025) of patients aged ≥18 years undergoing TAVR.
- Utilized current-generation self-expanding valves (Evolut, Navitor) and defined predicted PPM per VARC-3 criteria.
- Assessed all-cause mortality and heart failure hospitalization as primary outcomes over a 5-year follow-up period.
Main Results:
- PPM occurred in 5.0% of 2989 TAVR patients, with a declining incidence from 6.5% in 2017 to 2.7% in 2025.
- Independent predictors of PPM included female sex and valve-in-valve procedures; Navitor valve use was associated with lower PPM odds.
- Patients with PPM showed higher transvalvular gradients and smaller aortic valve areas but no significant difference in 5-year mortality or heart failure hospitalization.
Conclusions:
- PPM is infrequent in contemporary TAVR cohorts utilizing self-expanding valves and its incidence has decreased.
- Female sex and prior valve-in-valve procedures are significant predictors of PPM.
- Despite adverse hemodynamic profiles, PPM is not associated with adverse early or long-term clinical outcomes after TAVR.
