Video Experimental Relacionado

Updated: Mar 3, 2026

Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots

Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots

Published on: May 21, 2017

Impacto a Largo Plazo del Desajuste Prótesis-Paciente Después del Reemplazo Valvular Aórtico Transcatéter en

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

Abstracto

Background:

Prosthesis-patient mismatch (PPM) remains common following transcatheter aortic valve replacement (TAVR) and is associated with worse clinical outcomes. PPM is of particular concern in small aortic annuli (SAA).

Aims:

To compare the incidence, predictors, and long-term impact of PPM in SAA TAVR.

Methods:

Single-center retrospective registry analysis of native, severe aortic stenosis patients with computed tomography-derived annulus area ≤ 430 mm², undergoing TAVR via transfemoral access. Significant PPM was defined as moderate and above and classified by the Valve Academic Research Consortium (VARC)-3. Additional analyses were conducted for predicted PPM and gender-based criteria. Inverse probability treatment weighting (IPTW) was applied to identify predictors of significant PPM and long-term mortality.

Results:

The cohort included 631 consecutive patients with SAA undergoing TAVR between 2015 and 2024. Significant PPM occurred in 23.3%. Multivariable analyses identified BEV implantation (OR 2.1, 95% CI 1.3-4.9, p < 0.001) and larger body surface area (OR 4.6, 95% CI 1.7-18.8, p < 0.001) as independent predictors of PPM. Large annulus perimeter had a protective association (OR 0.85, 95% CI 0.79-0.91, p < 0.001). Five-year mortality was significantly higher among patients with significant PPM (32.0% vs. 25.4%; log-rank p = 0.008). Age (HR 1.04, 95% CI 1.004-1.07, p = 0.03), moderate and above paravalvular leak (HR 3.25, 95% CI 1.3-8.0, p = 0.01), and significant PPM (HR 1.97, 95% CI 1.2-3.1, p = 0.004) were independently associated with 5-year mortality.

Conclusions:

Significant PPM remains highly prevalent following SAA TAVR. BEV implantation and larger BSA were associated with significant PPM, and a larger implanted valve had a protective association. Significant PPM is independently associated with long-term mortality.

Palabras clave:

PPM TAVR válvulas expandibles por balón fuga paravalvular desajuste prótesis-paciente anillo aórtico pequeño

Más Videos Relacionados

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement

Published on: December 11, 2017

Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement

Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement

Published on: March 26, 2018

Videos de Conceptos Relacionados

Aneurysm III: Interprofessional Care

Aneurysm III: Interprofessional Care

Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...

Aortic Regurgitation I: Introduction

Aortic Regurgitation I: Introduction

IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...

Aortic Regurgitation III: Medical Management

Aortic Regurgitation III: Medical Management

Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...