Prosthesis-patient mismatch after transcatheter aortic valve implantation: prevalence and prognostic impact with respect to baseline left ventricular function

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 -