Okuno, Taishi; Khan, Faisal; Asami, Masahiko; Praz, Fabien; Heg, Dik; Winkel, Mirjam Gauri; Lanz, Jonas; Huber, Adrian; Gräni, Christoph; Räber, Lorenz; Stortecky, Stefan; Valgimigli, Marco; Windecker, Stephan; Pilgrim, Thomas (2019). Prosthesis-Patient Mismatch Following Transcatheter Aortic Valve Replacement With Supra-Annular and Intra-Annular Prostheses. JACC. Cardiovascular Interventions, 12(21), pp. 2173-2182. Elsevier 10.1016/j.jcin.2019.07.027
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Okuno JACCCardiovascInterv 2019_suppl material.pdf - Supplemental Material Available under License Creative Commons: Attribution-Noncommercial-No Derivative Works (CC-BY-NC-ND). Download (550kB) | Preview |
OBJECTIVES
This study sought to compare the frequency of prosthesis-patient mismatch (PPM) with self-expandable valves (SEV) to balloon-expandable valves (BEV).
BACKGROUND
PPM has been associated with increased mortality after transcatheter aortic valve replacement. Data on the frequency of PPM as a function of supra-annular or intra-annular position of transcatheter heart valves are insufficient.
METHODS
A total of 757 patients treated with SEV (CoreValve, Evolut R) and BEV (SAPIEN THV/XT/3) were enrolled in the present analysis between August 2007 and June 2017. PPM was classified based on discharge prosthetic effective orifice area indexed to body surface area (BSA) as severe (<0.65 cm2/m2) or moderate (0.65 to 0.85 cm2/m2) in the general population, and as severe (<0.60 cm2/m2) or moderate (0.60 to 0.90 cm2/m2) in the obese population (body mass index ≥30 kg/m2).
RESULTS
Propensity score matching resulted in 224 matched pairs. At discharge, SEV were associated with a lower incidence of PPM compared with BEV (PPM, 33.5% vs. 46.9%, p = 0.004; severe PPM, 6.7% vs. 15.6%, p = 0.003). The lower frequency of severe PPM in SEV was observed even in patients with larger annulus. Although patients with BSA >1.83 m2 had a significantly lower incidence of PPM with SEV compared with BEV, there was no significant difference in patients with BSA ≤1.83 m2. We found no impact of PPM on cardiovascular mortality or New York Heart Association functional class at 1 year.
CONCLUSIONS
SEV were associated with a lower frequency of PPM compared with BEV irrespective of annulus area. The difference was mainly driven by larger patients with BSA >1.83 m2.
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