A match not made in heaven—TAVR prosthesis‐patient mismatch with contemporary valves

Safi, Lucy; Turi, Zoltan G.

doi:10.1002/ccd.28201

Cited by 1 publication

(2 citation statements)

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“…In TAVR procedures for obese patients, valve sizing, particularly oversizing, plays a crucial role in outcomes. Oversizing TAVR valves in this demographic may prevent paravalvular leak (PVL) and mitigate PPM [ 25 ]. Optimal sizing in self-expanding TAVR valves lies between 10-20% oversizing [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

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Optimizing Valve Selection in Valve-in-Valve Transcatheter Aortic Valve Replacement: A Case Study on Addressing Patient-Prosthesis Mismatch and Early Structural Valve Deterioration in a Morbidly Obese Patient

Molina-Lopez,

Ortiz-Cartagena,

Mercado-Crespo

et al. 2024

Cureus

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Transcatheter aortic valve replacement (TAVR) has increasingly become a fundamental approach for treating aortic valve stenosis (AVS), especially in high surgical risk patients. This case study underscores the criticality of meticulous procedural planning and precise valve selection in patients with severe AVS compounded by obesity. We report a case of a patient who, after receiving a 26 mm Edwards Sapiens 3 valve, presented with worsening exertional dyspnea and a declining indexed effective orifice area (EOAi). This deterioration indicated early structural valve deterioration (SVD), presumably due to patient-prosthesis mismatch (PPM). A subsequent valve-in-valve (ViV) TAVR using a 29 mm Medtronic Evolut Fx valve was successfully executed, leading to a notable improvement in EOAi. This case study emphasizes the complexities inherent in valve choice and sizing in TAVR, particularly highlighting the impact of PPM on obese patients and its potential to precipitate early SVD. The report further explores the emerging strategies in addressing TAVR valve dysfunctions via ViV interventions, shedding light on the nuanced and dynamic nature of TAVR management in obese patients. It advocates for tailored treatment strategies in managing such intricate cases, demonstrating the evolving landscape of TAVR procedures.

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Section: Discussionmentioning

confidence: 99%

“…Oversizing TAVR valves in this demographic may prevent paravalvular leak (PVL) and mitigate PPM [25].…”

Section: Discussionmentioning

confidence: 99%

Optimizing Valve Selection in Valve-in-Valve Transcatheter Aortic Valve Replacement: A Case Study on Addressing Patient-Prosthesis Mismatch and Early Structural Valve Deterioration in a Morbidly Obese Patient

Molina-Lopez,

Ortiz-Cartagena,

Mercado-Crespo

et al. 2024

Cureus

View full text Add to dashboard Cite

show abstract

A match not made in heaven—TAVR prosthesis‐patient mismatch with contemporary valves

Abstract: Key Points Prosthesis‐patient mismatch (PPM) in TAVR is relatively common Valve oversizing can potentially prevent both paravalvular leak and PPM PPM may be avoidable if the expected Effective Orifice Area/Body Surface Area ratio is considered in decision making pre‐TAVR.

Cited by 1 publication

References 5 publications

Optimizing Valve Selection in Valve-in-Valve Transcatheter Aortic Valve Replacement: A Case Study on Addressing Patient-Prosthesis Mismatch and Early Structural Valve Deterioration in a Morbidly Obese Patient

Optimizing Valve Selection in Valve-in-Valve Transcatheter Aortic Valve Replacement: A Case Study on Addressing Patient-Prosthesis Mismatch and Early Structural Valve Deterioration in a Morbidly Obese Patient

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