eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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4/2017
vol. 13
 
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abstract:
Original paper

Patient-prosthesis mismatch in patients treated with transcatheter aortic valve implantation – predictors, incidence and impact on clinical efficacy. A preliminary study

Karol Zbroński
,
Bartosz Rymuza
,
Piotr Scisło
,
Kajetan Grodecki
,
Paulina Dobkowska
,
Marek Wawrzacz
,
Radosław Wilimski
,
Anna Słowikowska
,
Janusz Kochman
,
Krzysztof J. Filipiak
,
Grzegorz Opolski
,
Zenon Huczek

Adv Interv Cardiol 2017; 13, 4 (50): 281–287
DOI: https://doi.org/10.5114/aic.2017.71608
Online publish date: 2017/11/29
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Introduction: Patient-prosthesis mismatch (PPM) is relatively frequent after surgical aortic valve replacement (SAVR) and negatively impacts prognosis.

Aim: We sought to determine the frequency and clinical effects of PPM after transcatheter aortic valve implantation (TAVI).

Material and methods: Overall, 238 patients who underwent TAVI were screened. Moderate PPM was defined as indexed effective orifice area (EOAi) between 0.65 and 0.85 cm2/m2, and severe PPM as < 0.65 cm2/m2. All-cause mortality and the Valve Academic Research Consortium 2 (VARC-2) defined composite of clinical efficacy at 1 year were the primary endpoints.

Results: Finally, 201 patients were included (mean age: 79.6 ±7.4 years, 52% females). The femoral artery served as the delivery route in 79% and most of the prostheses were self-expanding (68%). Any PPM was present in 48 (24%) subjects, and only 7 (3.5%) had severe PPM. Body surface area (BSA) independently predicted any PPM (OR = 16.9, p < 0.001) whereas post-dilation tended to protect against PPM (OR = 0.46, p = 0.09). All-cause mortality was similar in patients with moderate or severe PPM as compared to those with no PPM (14.6% vs. 14.3% vs. 13.1%, respectively, log-rank p = 0.98). Neither moderate (OR = 1.6, 95% CI: 0.8–3.2, p = 0.16) nor severe PPM (OR = 1.67, 95% CI: 0.36–7.7, p = 0.51) had a significant impact on composite endpoint, or its elements, with the exception of transvalvular pressure gradient > 20 mm Hg.

Conclusions: Severe PPM after TAVI is rare, can be predicted by larger BSA and does not seem to affect mid-term mortality or composite clinical outcome. Larger studies are needed to find different independent predictors of PPM and elucidate its impact in terms of device durability and long-term clinical efficacy.
keywords:

transcatheter aortic valve implantation, patient-prosthesis mismatch, effective orifice area
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