Outcomes of Prosthesis-Patient Mismatch Following Supra-Annular Transcatheter Aortic Valve Replacement

Sengupta, Aditya; Alexis, Sophia L.; Bapat, Vinayak; Adams, David H.; Sharma, Samin K.; Kini, Annapoorna; Kodali, Susheel; Ramlawi, Basel; Gada, Hemal; Vora, Amit N.; Forrest, John K.; Kaple, Ryan; Liu, Fang; Reardon, Michael J.

doi:10.1016/j.jcin.2021.03.040

Cited by 54 publications

(41 citation statements)

References 35 publications

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“…Does the patient need other cardiac procedures, such as coronary artery bypass grafting (CABG), mitral valve surgery, or aortic surgery? 5. "What prosthetic effective orifice area (EOA) does the patient need?"…”

Section: Raising Questions For Now and Latermentioning

confidence: 99%

See 1 more Smart Citation

Lifetime management of aortic valve disease: Aligning surgical and transcatheter armamentarium to set the tone for the present and the future

Sá

Ramlawi

Sicouri

et al. 2021

Journal of Cardiac Surgery

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Transcatheter aortic valve replacement (TAVR) has already received the green light for high‐, intermediate‐ and low‐risk profiles and is an alternative for all patients regardless of age. It is clear that there has been a push towards the use of TAVR in younger and younger patients (<65 years), which has never been formally tested in randomized controlled trials but seems inevitable as TAVR technology makes steady progress. Lifetime management as a concept will set the tone in the field of the structural heart. Some subjects in this scenario arise, including the importance of optimized prosthetic hemodynamics for lifetime care; surgical procedures in the aortic root; management of structural valve degeneration with valve‐in‐valve procedures (TAVR‐in‐surgical aortic valve replacement [SAVR] and TAVR‐in‐TAVR) and redo SAVR; commissural alignment and cusp overlap for TAVR; the rise in the number of surgical procedures for TAVR explantation; and the renewed interest in the Ross procedure. This article reviews all these issues which will become commonplace during heart team meetings and preoperative conversations with patients in the coming years.

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Section: Raising Questions For Now and Latermentioning

confidence: 99%

“…The impact of PPM on clinical outcomes after SAVR/TAVR is not accepted universally because several studies 4–7 failed to show PPM as a risk factor for mortality and SVD. Nevertheless, several studies have demonstrated quite the contrary 2,3,8–10 …”

Section: Recognizing the Importance Of Optimized Prosthetic Valve Hem...mentioning

confidence: 99%

Lifetime management of aortic valve disease: Aligning surgical and transcatheter armamentarium to set the tone for the present and the future

Sá

Ramlawi

Sicouri

et al. 2021

Journal of Cardiac Surgery

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“…Recently, studies have questioned the prognostic impact of mismatch in the global population of TAVR. Concerning SE valves, Tang et al showed that the presence of a severe mismatch did not impact one-year mortality [ 18 ]. Conversely, for this type of valve, Leone et al demonstrated that severe PPM had an impact on the prognosis of patients after TAVR (higher rates of all cause mortality) [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Prosthesis–Patient Mismatch in Small Aortic Annuli: Self-Expandable vs. Balloon-Expandable Transcatheter Aortic Valve Replacement

Ferrara

Théron

Porto

et al. 2022

JCM

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Prosthesis–patient mismatch (PPM) is associated with worse outcomes following surgical aortic valve replacement (SAVR). PPM has been identified in a significant proportion of TAVR, particularly in patients with small aortic annuli. Our objective was to evaluate the hemodynamic performances of balloon-expandable (BE) (Sapiens 3TM) versus two different self-expandable (SE) (Evolut ProTM, Accurate NeoTM) TAVR devices in patients with small aortic annulus defined by a computed tomography aortic annulus area (AAA) between 330 and 440 mm2. We enrolled 131 consecutive patients corresponding to 76 Sapiens 3 23 mm (58.0%), 26 Evolut Pro (19.9%) and 29 Accurate Neo (22.1%). Mean age was 82.5 ± 7.06 years, 22.9% of patients were male and mean Euroscore was 4.0%. Mean AAA was 374 ± 27 mm2 for Sapiens 3, 383 ± 29 mm2 for Corevalve Evolut Pro and 389 ± 25 mm2 for Accurate Neo. BE devices were associated with significantly higher rates of PPM (39.5%) as compared to SE devices (15.4% for Corevalve Evolut Pro and 6.9% for Accurate Neo) (p < 0.0001). Paravalvular leaks ≥ 2/4 were more often observed in SE devices (15.4% for Corevalve Evolut Pro and 17.2% for Accurate Neo) than in BE devices (2.6%) (p = 0.007). In conclusion, SE TAVR devices did achieve better hemodynamic results despite higher rates of paravalvular leaks. Therefore, SE TAVI devices could be considered as first choice in small aortic anatomy.

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“…20 Tang et al evaluated the incidence, predictors, and outcomes of prosthesis-patient mismatch in patients implanted with supra-annular valves in both de novo TAVR and transcatheter aortic valve (TAV) insurgical aortic valve (SAV) in the TVT Registry. 21 Severe prosthesis-patient mismatch was found in 5.3% of patients undergoing de novo TAVR and 27% of patients undergoing TAV-in-SAV. The study demonstrated that an aortic annular diameter of <20 mm in de novo TAVR and TAV-in-SAV patients was a significant predictor of severe prosthesis-patient mismatch (p<0.001 for both).…”

Section: Prosthesis-patient Mismatchmentioning

confidence: 98%

“…25 SAVR with aortic root enlargement to accommodate a larger surgical bioprosthesis may be preferred to TAVR with a 23 mm supra-annular TAV. 21 Similarly, patients with pre-existing severe prosthesis-patient mismatch post-SAVR who are being considered for TAV-in-SAV will likely continue to have severe prosthesis-patient mismatch following TAVR. 21 Bioprosthetic valve fracture using a highpressure balloon has also been shown to result in reduced residual transvalvular gradients and increased valve EOA.…”

Section: Prosthesis-patient Mismatchmentioning

confidence: 99%

Transcatheter Aortic Valve Replacement Optimization Strategies: Cusp Overlap, Commissural Alignment, Sizing, and Positioning

Siddique

Khanal

Vora

et al. 2022

US Cardiology Review

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As transcatheter aortic valve replacement (TAVR) rapidly expands to younger patients and those at low surgical risk, there is a compelling need to identify patients at increased risk of post-procedural complications, such as paravalvular leak, prosthesis–patient mismatch, and conduction abnormalities. This review highlights the incidence and risk factors of these procedural complications, and focuses on novel methods to reduce them by using newer generation transcatheter heart valves and the innovative cusp-overlap technique, which provides optimal fluoroscopic imaging projection to allow for precise implantation depth which minimizes interaction with the conduction system. Preserving coronary access after TAVR is another important consideration in younger patients. This paper reviews the significance of commissural alignment to allow coronary cannulation after TAVR and discusses recently published data on modified delivery techniques to improve commissural alignment.

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Outcomes of Prosthesis-Patient Mismatch Following Supra-Annular Transcatheter Aortic Valve Replacement

Cited by 54 publications

References 35 publications

Lifetime management of aortic valve disease: Aligning surgical and transcatheter armamentarium to set the tone for the present and the future

Lifetime management of aortic valve disease: Aligning surgical and transcatheter armamentarium to set the tone for the present and the future

Prosthesis–Patient Mismatch in Small Aortic Annuli: Self-Expandable vs. Balloon-Expandable Transcatheter Aortic Valve Replacement

Transcatheter Aortic Valve Replacement Optimization Strategies: Cusp Overlap, Commissural Alignment, Sizing, and Positioning

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