Incidence and Prognosis of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement for Bicuspid Aortic Stenosis.

Background: Evidence regarding the incidence of prosthesis-patient mismatch (PPM) and long-term mortality after transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve stenosis (AS) is scarce.
Objectives: This study sought to assess the incidence and prognostic impact of PPM after TAVR for bicuspid AS compared with that for tricuspid AS.
Methods: In total, 7,393 patients who underwent TAVR were prospectively enrolled in the OCEAN-TAVI (Optimized Catheter Valvular Intervention Transcatheter Aortic Valve Implantation) registry, an ongoing Japanese, multicenter registry. We analyzed 7,051 patients (median age = 85 years, 68.4% women) and identified 503 (7.1%) with bicuspid AS. We compared the incidence of PPM and long-term mortality in 497 patients with and 497 without bicuspid AS after one-to-one propensity score matching analysis.
Results: Among the 7,051 patients, moderate and severe PPM were observed in 756 (10.7%) and 92 (1.3%) patients, respectively. Upon Kaplan-Meier curve analysis of the overall cohort, severe PPM appeared to be associated with long-term mortality (log-rank test, P = 0.065). After propensity score matching analysis, moderate and severe PPM were more frequently observed among patients with tricuspid AS than patients with bicuspid AS (moderate PPM, 11.7% vs 4.4%; severe PPM, 1.4% vs 1.0%; P = 0.0001).
Conclusions: Severe PPM appeared to be associated with all-cause mortality. Moderate and severe PPM were more frequently observed in patients with tricuspid AS than patients with bicuspid AS.
Competing Interests: Funding Support and Author Disclosures The OCEAN-TAVI registry is supported by Edwards Lifesciences, Medtronic, Boston Scientific, Abbott Medical, and Daiichi-Sankyo Company. Dr Yashima is a clinical proctor for Medtronic. Dr Ohno is a clinical proctor for Medtronic. Dr Izumo is a screening proctor for Edwards Lifesciences. Dr Asami is a clinical proctor for Medtronic. Dr Naganuma is a clinical proctor for Edwards Lifesciences and Medtronic. Dr Takagi is a clinical proctor for Edwards Lifesciences and Medtronic. Dr Mizutani is a clinical proctor for Edwards Lifesciences and Medtronic. Dr Tada is a clinical proctor for Edwards Lifesciences, Abbott Medical, and Medtronic. Dr Shirai is a clinical proctor for Edwards Lifesciences, Abbott Medical, and Medtronic. Dr Ueno is a clinical proctor for Edwards Lifesciences and Medtronic. Dr Watanabe is a clinical proctor for Edwards Lifesciences, Abbott Medical, and Medtronic. Dr Yamamoto is a clinical proctor for Edwards Lifesciences, Abbott Medical, and Medtronic. Dr Hayashida is a clinical proctor for Edwards Lifesciences, Abbott Medical, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(Copyright © 2025 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)