Prosthesis-Patient Mismatch Following Transcatheter Aortic Valve Replacement With Supra-Annular and Intra-Annular Prostheses.

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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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology

UniBE Contributor:

Khan, Faisal; Asami, Masahiko; Praz, Fabien; Heg, Dierik Hans; Winkel, Mirjam Gauri; Lanz, Jonas; Huber, Adrian Thomas; Gräni, Christoph; Räber, Lorenz; Stortecky, Stefan; Valgimigli, Marco; Windecker, Stephan and Pilgrim, Thomas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1876-7605

Publisher:

Elsevier

Language:

English

Submitter:

Maria de Fatima Henriques Bernardo

Date Deposited:

01 Oct 2019 16:19

Last Modified:

10 Nov 2019 01:32

Publisher DOI:

10.1016/j.jcin.2019.07.027

PubMed ID:

31564593

Uncontrolled Keywords:

aortic stenosis intra-annular valve prosthesis-patient mismatch supra-annular valve transcatheter aortic valve replacement

BORIS DOI:

10.7892/boris.133602

URI:

https://boris.unibe.ch/id/eprint/133602

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