Long-term outcomes of measured and predicted prosthesis-patient mismatch following transcatheter aortic valve replacement.

Tomii, Daijiro; Okuno, Taishi; Heg, Dik; Nakase, Masaaki; Lanz, Jonas; Praz, Fabien; Stortecky, Stefan; Reineke, David; Windecker, Stephan; Pilgrim, Thomas (2023). Long-term outcomes of measured and predicted prosthesis-patient mismatch following transcatheter aortic valve replacement. EuroIntervention, 19(9), pp. 746-756. Europa Digital & Publishing 10.4244/EIJ-D-23-00456

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BACKGROUND

Both measured and predicted effective orifice area (EOA) indexed to the body surface area (EOAi) have been suggested to define prosthesis-patient mismatch (PPM) in patients undergoing transcatheter aortic valve replacement (TAVR). The impact of PPM on clinical outcomes may accumulate with extended follow-up and vary according to the definition used.

AIMS

We aimed to investigate the long-term clinical impact of PPM in patients undergoing TAVR.

METHODS

Patients in a prospective TAVR registry were stratified by the presence of moderate (0.65-0.85 or 0.55-0.70 cm2/m2 if obese) or severe (≤0.65 or ≤0.55 cm2/m2 if obese) PPM according to echocardiographically measured EOAi (measured PPM), predicted EOAi based on published EOA reference values for each valve model and size (predicted PPMTHV), or predicted EOAi based on EOA reference values derived from computed tomography measurements of aortic annulus dimensions (predicted PPMCT).

RESULTS

In an analysis of 2,463 patients, the frequency of measured PPM (moderate: 27.0%; severe: 8.7%) was higher than the frequency of predicted PPMTHV (moderate: 11.3%; severe: 1.2%) or predicted PPMCT (moderate: 12.0%; severe: 0.1%). During a median follow-up of 429 days, 10-year mortality was comparable in patients with versus without measured PPM or predicted PPMCT. In contrast, patients with moderate predicted PPMTHV had a lower risk of 10-year all-cause mortality compared with those without PPM (adjusted hazard ratio: 0.73, 95% confidence interval: 0.55-0.96).

CONCLUSIONS

The use of predicted versus measured EOAi results in a lower estimate of PPM severity. We observed no increased risk of death in patients with PPM over a median follow-up time of 429 days.

CLINICALTRIALS

gov: NCT01368250.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Heart Surgery
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR)

UniBE Contributor:

Tomii, Daijiro, Okuno, Taishi, Heg, Dierik Hans, Lanz, Jonas, Praz, Fabien Daniel, Stortecky, Stefan, Reineke, David Christian, Windecker, Stephan, Pilgrim, Thomas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1774-024X

Publisher:

Europa Digital & Publishing

Language:

English

Submitter:

Pubmed Import

Date Deposited:

30 Aug 2023 13:03

Last Modified:

27 Feb 2024 14:27

Publisher DOI:

10.4244/EIJ-D-23-00456

PubMed ID:

37622754

BORIS DOI:

10.48350/185761

URI:

https://boris.unibe.ch/id/eprint/185761

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