Predictors and outcomes of patient‐prosthesis mismatch after transcatheter aortic valve replacement

Abstract

Background: Patient-prosthesis mismatch (PPM) has been shown to be associated with adverse outcomes after surgical aortic valve replacement. There is limited data on its risk and impact after transcatheter aortic valve replacement (TAVR), especially with the newer generation heart valves.Objectives: The objective of this study is to investigate the incidence, predictors, and clinical outcomes of PPM after TAVR.Methods: This is a retrospective study of 991 consecutive patients who underwent TAVR procedure at a tertiary referral center, between April 2012 and February 2019. Patients were stratified by the presence or absence of PPM, defined as an effective orifice area/body surface area ratio ≤0.85 cm 2 /m 2 . Multivariable logistic regression analysis was used to determine independent predictors of PPM. Kaplan-Meier survival estimates were used to determine overall 5-year survival.Results: PPM was encountered in 27.6% of patients. In multivariable analysis, age less than 70 years (P = .062), body mass index (BMI) more than 30 (P = .0057), history of atrial fibrillation (P = .0004), black race (P = .0078), and Sapien 3 sizes 20 and 23 mm (P < .0001)emerged as independent predictors of PPM. Sapien 3 valve size 20/23 mm was associated with higher risk of PPM compared to other valve types. Patients with PPM had comparable postoperative outcomes and overall 5-year survival. There was no significant difference in postoperative complications between patient groups. PPM was not associated with worse overall survival (56% for both PPM and no-PPM patients, log-rank P = .80).Conclusions: Younger age, atrial fibrillation, black race, higher BMI were predictors of PPM. Smaller sizes balloon-expandable valves had a higher risk of PPM. K E Y W O R D S aortic stenosis, cardiac surgery, patient-prosthesis mismatch, TAVR Abbreviations: TAVR, transcatheter aortic valve replacement; SAVR, surgical aortic valve replacement; PPM, patient-prosthesis mismatch; BMI, body mass index.

Predictors for the risk of permanent pacemaker implantation after transcatheter aortic valve replacement: A systematic review and meta‐analysis

“…89 The effect of mismatch on postoperative outcomes after TAVR is still controversial. 90 We performed a pooling analysis of six articles including 3358 patients (763 with patient prosthesis mismatch and 2595 without patient prosthesis mismatch) to reveal the impact of mismatch on the risk of permanent maker implantation after TAVR (Table 7). As is shown in Figure 10, the combined OR was 0.88 (95% CI: 0.67-1.16) without significant heterogeneity (I 2 = 0.0%, 95% CI: 0.0%-74.6%, p = .874).…”

Prevalence and Significance of Patient Prosthesis Mismatch Following Edwards SAPIEN XT and SAPIEN 3 Transcatheter Aortic Valve Replacement

“…Previous studies have also shown that smaller ES3 valves are associated with a higher incidence of sPPM [10,[16][17][18]22].…”

“…The latter was felt to be due to the new design and the introduction of the smaller valve size (i.e., 20 mm). Previous studies had also shown that smaller ES3 valves are associated with a higher incidence of sPPM [10,[16][17][18]22]. In our study, statistically significant differences were noted between ES XT and ES3 with regards to peak (14.6 ± 5.3 vs. 19.8 ± 8.6 mmHg, p < 0.0001) and mean (7.1 ± 2.7 vs. 10.2 ± 4.7 mmHg, p < 0.0001) trans-prosthetic gradients as well as the dimensionless index (0.57 ± 0.14 vs. 0.52 ± 0.12, p = 0.0008).…”

Predictors and risk-adjusted outcomes of new-onset postoperative atrial fibrillation in repeat surgical and valve-in-valve transcatheter aortic valve replacement

“…For first-time AVR procedures, POAF/AFL has been associated with worse mortality, higher rates of stroke, increased length of stay, and readmission [10,16,18,30,31] . Historically, the impact of POAF/AFL in r-AVR patients has not been similarly investigated.…”