Long-term outcome of prosthesis-patient mismatch after transcatheter aortic valve replacement

Compagnone, Miriam; Marchetti, Giulia; Taglieri, Nevio; Ghetti, Gabriele; Bruno, Antonio Giulio; Orzalkiewicz, Mateusz; Marrozzini, Cinzia; Reggiani, Maria-Letizia Bacchi; Palmerini, Tullio; Galiè, Nazzareno; Saia, Francesco

doi:10.1016/j.ijcard.2020.06.033

Cited by 15 publications

(13 citation statements)

References 17 publications

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“…To reduce the risk of PPM these valve‐related factors should be always taken into account, especially in patients with small aortic annulus and women. Yet, the lack of a significant prognostic clinical impact of PPM in the present report is interesting and consistent with other studies 3,5 . Is PPM after TAVR more benign in comparison with PPM after SAVR?…”

supporting

confidence: 93%

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Women and transcatheter aortic valve implantation: Also a mismatch could be tomorrow's best match

Saia

2021

Cathet Cardio Intervent

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Key Points What the article teaches. Patient prosthesis mismatch (PPM) occurs in a third of women after transcatheter aortic valve replacement (TAVR), in association with small valve size and higher BMI, apparently without short‐term clinical consequences. How it will impact practice. Implementation strategies to minimize the incidence of PPM in patients at risk, that are mainly women, is important. What new research/study would help answer the question posed. Differential clinical impact of PPM on TAVR and surgical aortic valve replacement should be further investigated, as well as the hypothesis that TAVR might represent the best therapeutic option for women with severe aortic stenosis.

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supporting

confidence: 93%

“…Further, the clinical consequences of PPM after TAVR are not well delineated 2 . While the detrimental effect of severe PPM on clinical outcomes seems confirmed, the impact of moderate PPM after TAVR is still unclear 3 …”

mentioning

confidence: 99%

Women and transcatheter aortic valve implantation: Also a mismatch could be tomorrow's best match

Saia

2021

Cathet Cardio Intervent

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“…The importance of forward-flow hemodynamics was stressed by Van Mieghem et al in a recent analysis on more than 2,000 patients from CoreValve US Pivotal High Risk and SURTAVI intermediate-risk trials: discharge Doppler velocity index (DVI ≤ 0.5 after TAVI was associated with higher 3-year mortality (24 vs. 18%, p = 0.025) and mortality or rehospitalization (37 vs. 20%, p = 0.007) (68). Similarly, the presence of severe PPM was associated with worse prognosis at 5 years in terms of composite endpoint of cardiovascular death, myocardial infarction, and stroke in a recent analysis on 710 patients (105).…”

Section: Transcatheter Aortic Valve Implantationmentioning

confidence: 97%

“…Despite the above evidence in patients undergoing SAVR, the clinical impact of PPM in patients undergoing TAVI is not entirely clear to date. On one hand, its impact on prosthetic hemodynamic function and on clinical outcomes was progressively more recognized even among patients treated percutaneously (70,79,101,102): PPM was associated with less improvement in functional class, with reduced regression of ventricular mass and diastolic dysfunction, and with increased mortality, especially when severe (67,(103)(104)(105). This is concordant with data from the STS/ACC TVT registry, which showed a significant difference at 1 year in terms of mortality in patients with severe, moderate and non-PPM (17.2, 15.6, and 15.9%, respectively, p = 0.02), as well as in terms of re-hospitalization for heart failure (14.7, 12.8, and 11.9%, respectively, p < 0.0001) (72).…”

Section: Transcatheter Aortic Valve Implantationmentioning

confidence: 99%

“…Indeed, several studies reported a more pronounced impact of PPM on survival in younger patients (64); the difference in age between TAVI series and SAVR series (age is often much higher in the former) may thus contribute to such described differences in outcomes. Moreover, while TAVI series have studied mostly the impact of PPM in the short-tomedium term (only few studies reported outcomes at 5 years as of today) (67,70,72,105), SAVR series have assessed its impact on long-term survival (up to 10 years) (25, 39, 64).…”

Section: Transcatheter Aortic Valve Implantationmentioning

confidence: 99%

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Clinical and Technical Challenges of Prosthesis–Patient Mismatch After Transcatheter Aortic Valve Implantation

Fazzari¹,

Cannata²,

Sánchez³

et al. 2021

Front. Cardiovasc. Med.

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Prosthesis–patient mismatch (PPM) is present when the effective area of a prosthetic valve inserted into a patient is inferior to that of a normal human valve; the hemodynamic consequence of a valve too small compared with the size of the patient's body is the generation of higher than expected transprosthetic gradients. Despite evidence of increased risk of short- and long-term mortality and of structural valve degeneration in patients with PPM after surgical aortic valve replacement, its clinical impact in patients subject to transcatheter aortic valve implantation (TAVI) is yet unclear. We aim to review and update on the definition and incidence of PPM after TAVI, and its prognostic implications in the overall population and in higher-risk subgroups, such as small aortic annuli or valve-in-valve procedures. Last, we will focus on the armamentarium available in order to reduce risk of PPM when planning a TAVI procedure.

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Hemodynamics of self-expanding versus balloon-expandable transcatheter heart valves in relation to native aortic annulus anatomy

Schmidt

Fortmeier

Ludwig³

et al. 2022

Clin Res Cardiol

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Objectives This study aimed to compare hemodynamic characteristics of different self-expanding (SE) and balloon-expandable (BE) transcatheter heart valves (THV) in relation to native aortic annulus anatomy. Background A patient centered THV selection becomes increasingly important as indications for transcatheter aortic valve replacement (TAVR) are extended towards lower risk populations. Methods Hemodynamic parameters including mean gradient (MG), effective orifice area (EOA), Doppler velocity index (DVI), degree of paravalvular regurgitation (PVR) and patient-prosthesis mismatch (PPM) were compared by valve type, label size and in relation to quintiles of native aortic annulus area. Results 2609 patients were treated at 3 centers in Germany with SAPIEN 3 (n = 1146), ACURATE Neo (n = 649), Evolut R (n = 546) or Evolut Pro (n = 268) THV. SE THVs provided superior hemodynamics in terms of larger EOA, higher DVI and lower MG compared to BE THV, especially in patients with small aortic annuli. Severe PPM was less frequent in SE treated patients. The rate of PVR ≥ moderate was comparable for SE and BE devices in smaller annular dimensions, but remarkably lower for BE TAVR in large aortic annular dimensions (> 547.64 mm2) (2% BE THV vs. > 10% for SE THV; p < 0.001). Conclusions Patients with small aortic annular dimensions may benefit hemodynamically from SE THV. With increasing annulus size, BE THV may have advantages since PVR ≥ moderate occurs less frequently. Graphical abstract

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Long-term outcome of prosthesis-patient mismatch after transcatheter aortic valve replacement

Cited by 15 publications

References 17 publications

Women and transcatheter aortic valve implantation: Also a mismatch could be tomorrow's best match

Women and transcatheter aortic valve implantation: Also a mismatch could be tomorrow's best match

Clinical and Technical Challenges of Prosthesis–Patient Mismatch After Transcatheter Aortic Valve Implantation

Hemodynamics of self-expanding versus balloon-expandable transcatheter heart valves in relation to native aortic annulus anatomy

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