Surgical versus transcatheter aortic valve replacement: Impact of patient‐prosthesis mismatch on outcomes

Abstract

Background The hemodynamics of most prosthetic valves are often inferior to that of the normal native valve, and a significant proportion of patients undergoing surgical (SAVR) or transcatheter aortic valve replacement (TAVR) have high residual transaortic pressure gradients due to prosthesis–patient mismatch (PPM). As the experience with TAVR has increased and long‐term outcomes are reported, a close look at the PPM literature is required in light of new evidence. Methods For this review, we searched the Embase, Medline, and Cochrane databases from 2000 to 2022. Articles reporting PPM as an outcome following aortic valve replacements were identified and reviewed. Results The impact of PPM on clinical outcomes in aortic valve replacement has not been clear as multiple studies failed to report PPM incidence. However, the PPM outcomes after SAVR vary more widely than after TAVR, ranging from 8% to 80% in SAVR and from 24% to 35% in TAVR. Incidence of severe PPM following redo SAVR ranges from 2% to 9% and following valve‐in‐valve TAVR is from 14% to 33%, however, while PPM is higher in valve‐in‐valve TAVR, patients had better survival rates. Conclusions The gap between valve performance and clinical outcomes in SAVR and TAVR could be reduced by carefully selecting patients for either treatment option. Understanding predictors of PPM can add to the safety, effectiveness, and increased survival benefit of both SAVR and TAVR.

Introductory Chapter: Heart Valve Surgery – Current Status and Future Directions

“…With the expansion of transcatheter therapy, data shows that implanting transcatheter valves inside degenerated smaller-size prostheses will result in creating gradient across that left ventricular outflow tract [11]. More emerging data supportive of the negative impact of patient-prosthesis mismatch on survival [12] drew the attention of the surgical community and currently, there are more trends to enlarge the aortic annulus with a variety of surgical techniques to accommodate a large enough prosthesis that will facilitate future transcatheter therapy.…”