Long-term impact of prosthesis-patient mismatch after transcatheter aortic valve replacement

Few studies have investigated the long-term impact of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR). The study aimed to evaluate the long-term outcomes of patients with PPM following TAVR. A retrospective analysis was conducted in 1,221 consecutive patients who underwent TAVR at our institution between October 2013 and December 2022. The primary outcomes were all-cause and cardiovascular mortality within 10 years after TAVR. Of the 1,221 patients, moderate and severe PPM were observed in 220 (18.0%) and 58 (4.8%) patients, respectively. The predictors of PPM included a larger body surface area, a history of atrial fibrillation, dialysis (hemodialysis or peritoneal dialysis), lower left ventricular ejection fraction, smaller annular area, and the use of a balloon-expandable valve. During a median follow-up of 1,098 days (interquartile range: 661-1,833 days), no significant association was observed between PPM and either all-cause mortality or cardiovascular mortality (all-cause mortality: log-rank P = 0.385; and cardiovascular mortality: log-rank P = 0.467, respectively). In patients with a Society of Thoracic Surgery score of < 4%, multivariable Cox regression analysis showed that severe PPM was associated with cardiovascular mortality (hazard ratio: 3.106, 95% confidence interval: 1.151-8.377; P = 0.025). This subgroup finding should be interpreted cautiously and warrants further investigation.