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Transcatheter Aortic Valve Replacement

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Determinants and Impact of Heart Failure Readmission Following Transcatheter Aortic Valve Replacement The Utility of Rapid Atrial Pacing Immediately Post-TAVR to Predict the Need for Pacemaker Implantation Randomized Evaluation of TriGuard 3 Cerebral Embolic Protection After Transcatheter Aortic Valve Replacement: REFLECT II Long-term outcome of prosthesis-patient mismatch after transcatheter aortic valve replacement Precision Medicine in TAVR: How to Select the Right Device for the Right Patient Safety and efficacy of a self-expanding versus a balloon-expandable bioprosthesis for transcatheter aortic valve replacement in patients with symptomatic severe aortic stenosis: a randomised non-inferiority trial Prognostic Value of Computed Tomography-Derived Extracellular Volume in TAVR Patients With Low-Flow Low-Gradient Aortic Stenosis Why and How to Measure Aortic Valve Calcification in Patients With Aortic Stenosis Anticoagulation After Surgical or Transcatheter Bioprosthetic Aortic Valve Replacement Left Ventricular Hypertrophy and Clinical Outcomes Over 5 Years After TAVR: An Analysis of the PARTNER Trials and Registries
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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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