Prosthesis-patient mismatch after transcatheter aortic valve implantation: prevalence and prognostic impact with respect to baseline left ventricular function
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Prosthesis-patient mismatch after transcatheter aortic valve implantation: prevalence and prognostic impact with respect to baseline left ventricular function. / Schofer, Niklas; Deuschl, Florian; Rübsamen, Nicole; Skibowski, Johanna; Seiffert, Moritz; Voigtländer, Lisa; Schaefer, Andreas; Schneeberger, Yvonne; Schirmer, Johannes; Reichenspurner, Hermann; Blankenberg, Stefan; Conradi, Lenard; Schäfer, Ulrich.
in: EUROINTERVENTION, Jahrgang 14, Nr. 16, 20.03.2019, S. 1648-1655.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Prosthesis-patient mismatch after transcatheter aortic valve implantation: prevalence and prognostic impact with respect to baseline left ventricular function
AU - Schofer, Niklas
AU - Deuschl, Florian
AU - Rübsamen, Nicole
AU - Skibowski, Johanna
AU - Seiffert, Moritz
AU - Voigtländer, Lisa
AU - Schaefer, Andreas
AU - Schneeberger, Yvonne
AU - Schirmer, Johannes
AU - Reichenspurner, Hermann
AU - Blankenberg, Stefan
AU - Conradi, Lenard
AU - Schäfer, Ulrich
PY - 2019/3/20
Y1 - 2019/3/20
N2 - AIMS: We aimed to assess the prevalence and features of prosthesis-patient mismatch (PPM) following transcatheter aortic valve implantation (TAVI) and its prognostic impact considering baseline left ventricular ejection fraction (LVEF).METHODS AND RESULTS: Data from 1,309 patients undergoing TAVI for severe aortic stenosis were derived from a single-centre dedicated TAVI registry. PPM was assessed according to echocardiography at discharge and was defined in accordance with VARC-2. Median follow-up time was 2.03 years. Moderate and severe PPM was detected in 22.9% and 12.9%, respectively. Patients with severe PPM had smaller annuli and more often received transcatheter heart valve (THV) sizes ≤23 mm. Supra-annular THV design showed the lowest rate of PPM. In patients with LVEF <40%, but not in those with LVEF ≥40%, severe PPM was associated with an increased three-year mortality rate (no vs. severe PPM for LVEF ≥40%: 34.6% vs. 29.5%, p=0.96; LVEF <40%: 45.1% vs. 68.0%, p=0.041) and was independently predictive of all-cause mortality according to multivariate analysis in these patients (HR 2.97; 95% CI: 1.58-5.59, p<0.001).CONCLUSIONS: The presence of severe PPM depends on annular dimensions and THV size and design and is an independent predictor of mortality in patients with reduced LVEF. Hence, the risk of PPM should be considered within the process of THV selection.
AB - AIMS: We aimed to assess the prevalence and features of prosthesis-patient mismatch (PPM) following transcatheter aortic valve implantation (TAVI) and its prognostic impact considering baseline left ventricular ejection fraction (LVEF).METHODS AND RESULTS: Data from 1,309 patients undergoing TAVI for severe aortic stenosis were derived from a single-centre dedicated TAVI registry. PPM was assessed according to echocardiography at discharge and was defined in accordance with VARC-2. Median follow-up time was 2.03 years. Moderate and severe PPM was detected in 22.9% and 12.9%, respectively. Patients with severe PPM had smaller annuli and more often received transcatheter heart valve (THV) sizes ≤23 mm. Supra-annular THV design showed the lowest rate of PPM. In patients with LVEF <40%, but not in those with LVEF ≥40%, severe PPM was associated with an increased three-year mortality rate (no vs. severe PPM for LVEF ≥40%: 34.6% vs. 29.5%, p=0.96; LVEF <40%: 45.1% vs. 68.0%, p=0.041) and was independently predictive of all-cause mortality according to multivariate analysis in these patients (HR 2.97; 95% CI: 1.58-5.59, p<0.001).CONCLUSIONS: The presence of severe PPM depends on annular dimensions and THV size and design and is an independent predictor of mortality in patients with reduced LVEF. Hence, the risk of PPM should be considered within the process of THV selection.
KW - Aortic Valve
KW - Aortic Valve Stenosis
KW - Humans
KW - Prevalence
KW - Prognosis
KW - Respect
KW - Transcatheter Aortic Valve Replacement
KW - Treatment Outcome
KW - Ventricular Function, Left
U2 - 10.4244/EIJ-D-18-00827
DO - 10.4244/EIJ-D-18-00827
M3 - SCORING: Journal article
C2 - 30418159
VL - 14
SP - 1648
EP - 1655
JO - EUROINTERVENTION
JF - EUROINTERVENTION
SN - 1774-024X
IS - 16
ER -