Impact of Prosthesis‐Patient Mismatch on Left Ventricular Myocardial Mechanics After Transcatheter Aortic Valve Replacement

Poulin, Frédéric; Yingchoncharoen, Teerapat; Wilson, William; Horlick, Eric; Généreux, Philippe; Tuzcu, E. Murat; Stewart, William J.; Osten, Mark; Woo, Anna; Thavendiranathan, Paaladinesh

doi:10.1161/jaha.115.002866

Cited by 33 publications

(30 citation statements)

References 38 publications

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“…The median number of patients per study was 120 (interquartile range 60-292) with median followup of 5 years (interquartile range 5-6 years, mean follow-up 5.6 years). These studies included 23 single-center studies (6,10,) and 8 multi-center studies (39)(40)(41)(42)(43)(44)(45)(46), where 14 were retrospective and 15 had prospective enrolment. The studies were conducted in the UK, Italy, Germany, US, Canada, Spain, Israel, Denmark and Sweden.…”

Section: Resultsmentioning

confidence: 99%

Long term outcomes of transcatheter aortic valve implantation (TAVI): a systematic review of 5-year survival and beyond

Chakos

Wilson-Smith

Arora

et al. 2017

Ann. Cardiothorac. Surg.

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Background: Transcatheter aortic valve implantation/replacement (TAVI/TAVR) is becoming more frequently used to treat aortic stenosis (AS), with increasing push for the procedure in lower risk patients.Numerous randomized controlled trials have demonstrated that TAVI offers a suitable alternative to the current gold standard of surgical aortic valve replacement (SAVR) in terms of short-term outcomes. The present review evaluates long-term outcomes following TAVI procedures.Methods: Literature search using three electronic databases was performed up to June 2017. Studies which included 20 or more patients undergoing TAVI procedures, either as a stand-alone or concomitant procedure and with a follow-up of at least 5 years, were included in the present review. Literature search and data extraction were performed by two independent researchers. Digitized survival data were extracted from Kaplan-Meier curves in order to re-create the original patient data using an iterative algorithm and subsequently aggregated for analysis.Results: Thirty-one studies were included in the present analysis, with a total of 13,857 patients. Two studies were national registries, eight were multi-institutional collaborations and the remainder were institutional series. Overall, 45.7% of patients were male, with mean age of 81.5±7.0 years. Where reported, the mean Logistic EuroSCORE (LES) was 22.1±13.7 and the mean Society of Thoracic Surgeons (STS) score was 9.2±6.6. The pooled analysis found 30-day mortality, cerebrovascular accidents, acute kidney injury (AKI) and requirement for permanent pacemaker (PPM) implantation to be 8.4%, 2.8%, 14.4%, and 13.4%, respectively. Aggregated survival at 1-, 2-, 3-, 5-and 7-year were 83%, 75%, 65%, 48% and 28%, respectively. Conclusions:The present systematic review identified acceptable long-term survival results for TAVI procedures in an elderly population. Extended follow-up is required to assess long-term outcomes following TAVI, particularly before its application is extended into wider population groups. Ann Cardiothorac Surg 2017;6(5):432-443 www.annalscts.com IntroductionAs Western populations age, the prevalence of aortic stenosis (AS) is gradually increasing (1). In a select population, surgical aortic valve replacement (SAVR) is precluded by patient frailty and other comorbidities (2). The availability of transcatheter aortic valve implantation/ replacement (TAVI/TAVR), pioneered in the early 2000s, has made a significant impact on survival for these patients (3-5). These early successes led to a number of trials, such as the PARTNER and US Pivotal trials, which compared TAVI, SAVR and standard treatment outcomes ( Figure 1). As a result, TAVI is increasingly being considered as a less-invasive option for treatment of AS in younger and lower surgical risk patients, where SAVR is not necessarily contraindicated (6,7), although this is not without controversy (8).While the short-term outcomes of TAVI have been well explored, limited studies have examined longer term results (9,10). Additiona...

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Section: Resultsmentioning

confidence: 99%

Long term outcomes of transcatheter aortic valve implantation (TAVI): a systematic review of 5-year survival and beyond

Chakos

Wilson-Smith

Arora

et al. 2017

Ann. Cardiothorac. Surg.

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“…9 PPM post-TAVI has been associated with less regression of LV hypertrophy, LV diastolic dysfunction, LV filling pressure (measured by E/e'), less improvement in LV systolic function (LVEF and myocardial strain), and less reduction of left atrial volume. 11,28,29 Interestingly, however, there may be a differential impact of PPM on mortality in patients treated with TAVI and those with SAVR. 6,9,13,27,29 In the study by Pibarot et al 9 an increased mortality was seen in surgical patients with PPM but not in TAVI patients.…”

Section: Discussionmentioning

confidence: 99%

Prevalence, predictors, and outcomes of patient prosthesis mismatch in women undergoing TAVI for severe aortic stenosis: Insights from the WIN‐TAVI registry

Panoulas

Chandrasekhar

Busi

et al. 2020

Cathet Cardio Intervent

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Objective: To evaluate the incidence, predictors and outcomes of female patients with patient-prosthesis mismatch (PPM) following transcatheter aortic valve intervention (TAVI) for severe aortic stenosis (AS). Background: Female AS TAVI recipients have a significantly lower mortality than surgical aortic valve replacement (SAVR) recipients, which could be attributed to the potentially lower PPM rates. TAVI has been associated with lower rates of PPM compared to SAVR. PPM in females post TAVI has not been investigated to date. Methods: The WIN-TAVI (Women's INternational Transcatheter Aortic Valve Implantation) registry is a multicenter registry of women undergoing TAVR for severe symptomatic AS. Two hundred and fifty patients with detailed periprocedural and followup echocardiographic investigations were included in the WIN-TAVI echocardiographic sub-study. PPM was defined as per European guidelines stratified by the presence of obesity. Results: The incidence of PPM in our population was 32.8%. Patients with PPM had significantly higher BMI (27.4 ± 6.1 vs. 25.2 ± 5.0, p = .002), smaller sized valves implanted (percentage of TAVI ≤23 mm 61% vs. 29.2%, PPM vs. no PPM, p < .001) and were more often treated with balloon expandable valves (48.3 vs. 32.5%, p < .001) rather than self expanding ones (26.3 vs. 52.8%, <.001). BMI (OR = 1.08; 95%CI 1.02-1.14, p = .011) and valve size ≤23 mm (OR = 3.00 95%CI 1.14-7.94, p = .027) were the only independent predictors of PPM. There was no significant interaction between valve size and valve type (p = .203). No significant differences were observed in 1-year mortality or major adverse cardiovascular events. Conclusions: PPM in females undergoing TAVI occurs in one third of patients. BMI and valve size ≤23 mm are independent predictors. Larger registries are required to determine the impact of PPM on future clinical outcomes.

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“…Post-TAVR prosthesis–patient mismatch (PPM) incidence was reported up to 42%, with a severe PPM rate of 9% [ 6 , 41 ]. A negative impact of PPM on LV remodeling and function was reported.…”

Section: Impact Of Prosthesis-patient Mismatch and Aortic Regurgitatimentioning

confidence: 99%

“…Although a higher rate of post-TAVR PVR was found in patients without PPM than in those with PPM (41 versus 17%, p = 0.01), higher diastolic function improvement and more LV mass regression was found in the no-PPM group versus the PPM group. However, no significant difference was found in midterm survival rates between PPM and no-PPM groups [ 41 ]. In one report, PPM occurred most commonly in patients who underwent TAVR with smaller-size prosthetics (Sapein and CoreValve size < 29 mm) [ 41 ].…”

Section: Impact Of Prosthesis-patient Mismatch and Aortic Regurgitatimentioning

confidence: 99%

“…However, no significant difference was found in midterm survival rates between PPM and no-PPM groups [ 41 ]. In one report, PPM occurred most commonly in patients who underwent TAVR with smaller-size prosthetics (Sapein and CoreValve size < 29 mm) [ 41 ]. On the other hand, it was suggested that patients with a larger aortic annulus can have suboptimal valve deployment due to less prosthesis–annulus congruence, leading to post-TARV PVR [ 42 ].…”

Section: Impact Of Prosthesis-patient Mismatch and Aortic Regurgitatimentioning

confidence: 99%

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Left Ventricular Diastolic Dysfunction and Transcatheter Aortic Valve Replacement Outcomes: A Review

Aalaei‐Andabili

Bavry

2019

Cardiol Ther

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Aortic stenosis (AS) is the most common valvular disease that can lead to increased afterload, left ventricular (LV) remodeling, and myocardial fibrosis. We reviewed the literature addressing the impact of transcatheter aortic valve replacement (TAVR) on LV remodeling and patients’ outcomes by elimination of AS-related high afterload. TAVR reduces afterload and improves LV remodeling recovery. However, myocardial fibrosis may not completely reverse after the TAVR. The LV diastolic dysfunction (LVDD) induced by AS is an independent predictor of post-TAVR mortality, and mortality increases with severity of LVDD. The impact of diastolic dysfunction on patient outcomes emerges at 30 days but continues to persist during mid-term follow-up. Based on severity of the baseline LVDD, some patients may tolerate post-TAVR aortic regurgitation (AR), but even minimal post-TAVR AR in patients with severe baseline LVDD can have an additive negative impact on survival. It is crucial to consider TAVR prior to development of advanced LVDD. Appropriate device selection and deployment technique are important in improvement of TAVR outcomes via elimination of AR.

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Impact of Prosthesis‐Patient Mismatch on Left Ventricular Myocardial Mechanics After Transcatheter Aortic Valve Replacement

Cited by 33 publications

References 38 publications

Long term outcomes of transcatheter aortic valve implantation (TAVI): a systematic review of 5-year survival and beyond

Long term outcomes of transcatheter aortic valve implantation (TAVI): a systematic review of 5-year survival and beyond

Prevalence, predictors, and outcomes of patient prosthesis mismatch in women undergoing TAVI for severe aortic stenosis: Insights from the WIN‐TAVI registry

Left Ventricular Diastolic Dysfunction and Transcatheter Aortic Valve Replacement Outcomes: A Review

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