Haemodynamic and clinical outcomes at 5 years according to predicted prosthesis-patient mismatch after transcatheter aortic valve replacement.

Background/purpose: Although the impact of predicted prosthesis-patient mismatch (PPM _P ) on outcomes after surgical aortic valve replacement is well established, studies on PPM _P in transcatheter aortic valve replacement (TAVR) are limited. This study investigated the effects of PPM _p on haemodynamic and 5-year clinical outcomes after TAVR.
Methods/materials: We analysed 1733 patients who underwent TAVR. PPM _p was defined using two different methods: 1) normal reference values of the effective orifice area for each valve type and size indexed to body surface area (PPM _p1 ; n = 1733) and 2) reference values for aortic annulus area or perimeter assessed with pre-procedural computed tomography indexed to body surface area (PPM _p2 ; n = 1227). The primary endpoint was the composite of all-cause death and/or rehospitalisation for heart failure at 5 years.
Results: The incidence of PPM _p1 was 11.7 % and 0.8 % in moderate and severe cases, respectively. PPM _p2 was classified as either moderate (3.8 %) or severe (0 %). Rates of residual mean aortic gradient ≥20 mmHg significantly increased depending on PPM _p1 severity (no PPM _p1 : 3.1 % vs. moderate PPM _p1 : 26.8 % vs. severe PPM _p1 : 53.9 %, p < 0.0001) and PPM _p2 (no PPM _p2 : 4.1 % vs. moderate PPM _p2 : 12.8 %, p = 0.0049). Neither of PPM _P methods were associated with the composite outcome in total cohort; however, PPM _P1 was significantly related to worse clinical outcomes at 5 years among patients with reduced left ventricular ejection fraction (LVEF) in multivariate analysis (HR: 1.87; 95 % CI: 1.02-3.43).
Conclusions: The impact of PPM _P on TAVR clinical outcomes may not be negligible in patients with low LVEF.
Competing Interests: Declaration of competing interest T.O. has received honoraria for lectures from Medtronic. K.S. has received honoraria for lectures from Medtronic. M.J. has received honoraria for lectures from Edwards Lifesciences and Medtronic. T.V. is a clinical proctor of Edwards Lifesciences (SAPIEN). M.L. reports receiving non-regulatory research grants from Teleflex and consultant fees from Boston Scientific, Edwards Lifesciences, and Medtronic. S.S is a clinical proctor of Edwards Lifesciences (SAPIEN), Medtronic (CoreValve) and Abbott (Navitor). N.M. has received honoraria for lectures from Abbott, Edwards Lifesciences, and Medtronic. And N.M. is a clinical proctor of Edwards Lifesciences (SAPIEN) and Boston Scientific (ACURATE neo), and received a research grant from the Japanese Circulation Society. The other authors have no potential conflicts of interest to declare.
(Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)