Haemodynamic and clinical outcomes at 5 years according to predicted prosthesis-patient mismatch after transcatheter aortic valve replacement

Yoichi Sugiyama; Hirokazu Miyashita; Tomoki Ochiai; Koki Shishido; Mikko Jalanko; Futoshi Yamanaka; Tommi Vähäsilta; Shigeru Saito; Mika Laine; Noriaki Moriyama

doi:10.1016/j.carrev.2024.06.011

Haemodynamic and clinical outcomes at 5 years according to predicted prosthesis-patient mismatch after transcatheter aortic valve replacement

Cardiovasc Revasc Med. 2024 Jun 19:S1553-8389(24)00541-4. doi: 10.1016/j.carrev.2024.06.011. Online ahead of print.

Affiliations

¹ Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa 247-8533, Japan; Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland.
² Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa 247-8533, Japan.
³ Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland.
⁴ Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa 247-8533, Japan. Electronic address: e2718nm@gmail.com.

PMID: 38944598
DOI: 10.1016/j.carrev.2024.06.011

Abstract

Background/purpose: Although the impact of predicted prosthesis-patient mismatch (PPM_P) on outcomes after surgical aortic valve replacement is well established, studies on PPM_P in transcatheter aortic valve replacement (TAVR) are limited. This study investigated the effects of PPM_p on haemodynamic and 5-year clinical outcomes after TAVR.

Methods/materials: We analysed 1733 patients who underwent TAVR. PPM_p was defined using two different methods: 1) normal reference values of the effective orifice area for each valve type and size indexed to body surface area (PPM_p1; n = 1733) and 2) reference values for aortic annulus area or perimeter assessed with pre-procedural computed tomography indexed to body surface area (PPM_p2; n = 1227). The primary endpoint was the composite of all-cause death and/or rehospitalisation for heart failure at 5 years.

Results: The incidence of PPM_p1 was 11.7 % and 0.8 % in moderate and severe cases, respectively. PPM_p2 was classified as either moderate (3.8 %) or severe (0 %). Rates of residual mean aortic gradient ≥20 mmHg significantly increased depending on PPM_p1 severity (no PPM_p1: 3.1 % vs. moderate PPM_p1: 26.8 % vs. severe PPM_p1: 53.9 %, p < 0.0001) and PPM_p2 (no PPM_p2: 4.1 % vs. moderate PPM_p2: 12.8 %, p = 0.0049). Neither of PPM_P methods were associated with the composite outcome in total cohort; however, PPM_P1 was significantly related to worse clinical outcomes at 5 years among patients with reduced left ventricular ejection fraction (LVEF) in multivariate analysis (HR: 1.87; 95 % CI: 1.02-3.43).

Conclusions: The impact of PPM_P on TAVR clinical outcomes may not be negligible in patients with low LVEF.

Keywords: Aortic stenosis; Left ventricular ejection fraction; Predicted prosthesis-patient mismatch; Transcatheter aortic valve replacement.