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Transcatheter Aortic Valve Replacement

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Impact of myocardial fibrosis on left ventricular remodelling, recovery, and outcome after transcatheter aortic valve implantation in different haemodynamic subtypes of severe aortic stenosis Minimum Core Data Elements for Evaluation of TAVR: A Scientific Statement by PASSION CV, HVC, and TVT Registry Comparison of Early Surgical or Transcatheter Aortic Valve Replacement Versus Conservative Management in Low-Flow, Low-Gradient Aortic Stenosis Using Inverse Probability of Treatment Weighting: Results From the TOPAS Prospective Observational Cohort Study Prognostic implications of baseline 6‐min walk test performance in intermediate risk patients undergoing transcatheter aortic valve replacement A Controlled Trial of Rivaroxaban After Transcatheter Aortic-Valve Replacement Prevalence and Outcomes of Concomitant Aortic Stenosis and Cardiac Amyloidosis Minimalist transcatheter aortic valve replacement: The new standard for surgeons and cardiologists using transfemoral access? Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients Temporal Trends, Characteristics, and Outcomes of Infective Endocarditis After Transcatheter Aortic Valve Replacement Poor Long-Term Survival in Patients With Moderate Aortic Stenosis
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Original Research2020 Jul 5;S0167-5273(20)33411-2.

JOURNAL：Int J Cardiol . Article Link

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

M Compagnone, G Marchetti, F Saia et al. Keywords: aortic valve stenosis; degenerated aortic valve bioprosthesis; prosthesis-patient mismatch; TAVR

ABSTRACT

BACKGROUND - Incidence and long-term clinical consequences of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) are still unclear.


METHODS - We enrolled 710 consecutive patients who underwent TAVR. PPM was defined as absent if the index orifice area (iEOA) was >0.85 cm2/m2, moderate if the iEOA was between 0.65 and 0.85 cm2/m2 or severe if the iEOA was <0.65 cm2/m2.

RESULTS - Among the 566 patients fulfilling the study criteria, the distribution of PPM was as follows: 50.5% none ( n = 286), 43% moderate PPM ( n = 243) and 6.5% severe PPM ( n = 37). At 5-year follow-up, patients with severe PPM had a significantly higher incidence of the combined endpoint of cardiovascular death, acute myocardial infarction and stroke ( p = .025) compared with the other patients. After adjusting the results for possible confounders, severe PPM remained an independent predictor of long-term adverse outcome (HR: 2.46; 95% Confidence Interval: 1.10–5.53). The independent predictors of severe PPM were valve-in-valve procedure and body mass index. Balloon-expandable valves were not associated with higher rates of severe PPM in comparison with self-expandable valves (5% vs. 8%, respectively, p = .245).


CONCLUSIONS -In our study severe PPM emerged as a risk factor for long-term major adverse cardiac and cerebrovascular events.
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