eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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vol. 13
Original paper

Patient-prosthesis mismatch in patients treated with transcatheter aortic valve implantation – predictors, incidence and impact on clinical efficacy. A preliminary study

Karol Zbroński
Bartosz Rymuza
Piotr Scisło
Kajetan Grodecki
Paulina Dobkowska
Marek Wawrzacz
Radosław Wilimski
Anna Słowikowska
Janusz Kochman
Krzysztof J. Filipiak
Grzegorz Opolski
Zenon Huczek

Adv Interv Cardiol 2017; 13, 4 (50): 281–287
Online publish date: 2017/11/29
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Introduction: Patient-prosthesis mismatch (PPM) is relatively frequent after surgical aortic valve replacement (SAVR) and negatively impacts prognosis.

Aim: We sought to determine the frequency and clinical effects of PPM after transcatheter aortic valve implantation (TAVI).

Material and methods: Overall, 238 patients who underwent TAVI were screened. Moderate PPM was defined as indexed effective orifice area (EOAi) between 0.65 and 0.85 cm2/m2, and severe PPM as < 0.65 cm2/m2. All-cause mortality and the Valve Academic Research Consortium 2 (VARC-2) defined composite of clinical efficacy at 1 year were the primary endpoints.

Results: Finally, 201 patients were included (mean age: 79.6 ±7.4 years, 52% females). The femoral artery served as the delivery route in 79% and most of the prostheses were self-expanding (68%). Any PPM was present in 48 (24%) subjects, and only 7 (3.5%) had severe PPM. Body surface area (BSA) independently predicted any PPM (OR = 16.9, p < 0.001) whereas post-dilation tended to protect against PPM (OR = 0.46, p = 0.09). All-cause mortality was similar in patients with moderate or severe PPM as compared to those with no PPM (14.6% vs. 14.3% vs. 13.1%, respectively, log-rank p = 0.98). Neither moderate (OR = 1.6, 95% CI: 0.8–3.2, p = 0.16) nor severe PPM (OR = 1.67, 95% CI: 0.36–7.7, p = 0.51) had a significant impact on composite endpoint, or its elements, with the exception of transvalvular pressure gradient > 20 mm Hg.

Conclusions: Severe PPM after TAVI is rare, can be predicted by larger BSA and does not seem to affect mid-term mortality or composite clinical outcome. Larger studies are needed to find different independent predictors of PPM and elucidate its impact in terms of device durability and long-term clinical efficacy.

transcatheter aortic valve implantation, patient-prosthesis mismatch, effective orifice area

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