Impact of Measured and Predicted Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement

Henning Guthoff; Mohamed Abdel-Wahab; the IMPPACT TAVR Investigators; Won Keun Kim; Guy Witberg; Hendrik Wienemann; Maria Thurow; Jasmin Shamekhi; Clemens Eckel; Ina von der Heide; Verena Veulemans; Martin Landt; Marco Barbanti; Ariel Finkelstein; Jury Schewel; Nicolas Van Mieghem; Rik Adrichem; Stefan Toggweiler; Tobias Rheude; Luis Nombela-Franco; Ignacio J. Amat-Santos; Philipp Ruile; Rodrigo Estévez-Loureiro; Matjaz Bunc; Luca Branca; Ole De Backer; Giuseppe Tarantini; Darren Mylotte; Dabit Arzamendi; Markus Pauly; Sabine Bleiziffer; Matthias Renker; Baravan Al-Kassou; Helge Möllmann; Sebastian Ludwig; Tobias Zeus; Corrado Tamburino; Tobias Schmidt; Andreas Rück; Philipp von Stein; Holger Thiele; Ahmed Abdelhafez; Matti Adam; Stephan Baldus; Tanja Rudolph; Victor Mauri

doi:10.1016/j.jcin.2024.08.041

Impact of Measured and Predicted Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement

Henning Guthoff
, Mohamed Abdel-Wahab
, the IMPPACT TAVR Investigators
, Won Keun Kim
, Guy Witberg
, Hendrik Wienemann
, Maria Thurow
, Jasmin Shamekhi
, Clemens Eckel
, Ina von der Heide
, Verena Veulemans
, Martin Landt
, Marco Barbanti
, Ariel Finkelstein
, Jury Schewel
, Nicolas Van Mieghem
, Rik Adrichem
, Stefan Toggweiler
, Tobias Rheude
, Luis Nombela-Franco

Ignacio J. Amat-Santos, Philipp Ruile, Rodrigo Estévez-Loureiro, Matjaz Bunc, Luca Branca, Ole De Backer, Giuseppe Tarantini, Darren Mylotte, Dabit Arzamendi, Markus Pauly, Sabine Bleiziffer, Matthias Renker, Baravan Al-Kassou, Helge Möllmann, Sebastian Ludwig, Tobias Zeus, Corrado Tamburino, Tobias Schmidt, Andreas Rück, Philipp von Stein, Holger Thiele, Ahmed Abdelhafez, Matti Adam, Stephan Baldus, Tanja Rudolph, Victor Mauri^*

^*Corresponding author for this work

University of Cologne
Fresenius AG
Kerckhoff Heart Center
Justus Liebig University Giessen
German Centre for Cardiovascular Research
Rabin Medical Center Israel
TU Dortmund University
University Hospital Bonn
St.-Johannes-Hospital Dortmund
University of Hamburg
Universitätsklinikum Düsseldorf
Segeberger Kliniken
Kore University of Enna
Tel Aviv Sourasky Medical Center
Marienkrankenhaus Hamburg
Asklepios Klinik St. Georg
Kantonsspital Luzern
Technical University of Munich
Hospital Clínico San Carlos de Madrid
Centro de Investigación Biomédica en Red (CIBER)
Hospital Clínico Universitario de Valladolid
University of Freiburg
Complejo Hospitalario Universitario
Ljubljanski Univerzitetni Klinicni Center
Brescia Civil Hospital
Rigshospitalet
University of Padua
Galway University Hospital
Hospital de La Santa Creu I Sant Pau
Ruhr University Bochum
University of Catania
Universitätsklinikum Schleswig-Holstein
Karolinska University Hospital
German Center for Neurodegenerative Diseases

Research output: Contribution to journal › Article › Academic › peer-review

14 Citations (Scopus)

294 Downloads (Pure)

Abstract

Background:

Prosthesis-patient mismatch after transcatheter aortic valve replacement (TAVR) can be measured echocardiographically (measured prosthesis-patient mismatch [PPMm]) or predicted (predicted prosthesis-patient mismatch [PPMp]) using published effective orifice area (EOA) reference values. However, the clinical implications of PPM post-TAVR remain unclear.

Objectives:

This study aimed to elucidate the prevalence of PPMm and PPMp post-TAVR and their impact on mortality in a large international cohort.

Methods:

The IMPPACT TAVR (Impact of Measured or Predicted Prosthesis-pAtient mismatCh after TAVR) registry included 38,808 TAVR patients from 26 international centers. Valve Academic Research Consortium 3 criteria were used to define prosthesis-patient mismatch severity. EOA was determined echocardiographically (PPMm) or predicted (PPMp) based on core lab–derived EOA reference values. The primary endpoint was 2-year all-cause mortality.

Results:

The prevalence of PPMp (moderate: 6.8%, severe: 0.6%) was significantly lower than that of PPMm (moderate: 20.7%, severe: 4.3%; P < 0.001) with negligible correlation between the 2 methods (Kendall's tau c correlation coefficient: 0.063; P < 0.001). In unadjusted analyses, severe PPMm adversely influenced 2-year survival (HR: 1.22; 95% CI: 1.02-1.45; P = 0.027), whereas severe PPMp was not associated with outcomes (HR: 0.81; 95% CI: 0.55-1.19; P = 0.291). After adjusting for confounders, neither PPMm nor PPMp had a significant effect on 2-year all-cause mortality.

Conclusions:

PPMm and PPMp were associated with different patient characteristics, with PPMm tending toward worse (especially low flow) and PPMp toward better (especially women) survival. After adjusting for confounders, neither PPMm nor PPMp significantly affected 2-year all-cause mortality. Hence, valve selection should not solely be based on hemodynamics but rather on a holistic approach, including patient and procedural specifics.

Original language	English
Pages (from-to)	2626-2635
Number of pages	10
Journal	JACC: Cardiovascular Interventions
Volume	17
Issue number	22
DOIs	https://doi.org/10.1016/j.jcin.2024.08.041
Publication status	Published - 25 Nov 2024

Bibliographical note

Publisher Copyright:
© 2024 The Authors

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Guthoff, H., Abdel-Wahab, M., the IMPPACT TAVR Investigators, Kim, W. K., Witberg, G., Wienemann, H., Thurow, M., Shamekhi, J., Eckel, C., von der Heide, I., Veulemans, V., Landt, M., Barbanti, M., Finkelstein, A., Schewel, J., Van Mieghem, N., Adrichem, R., Toggweiler, S., Rheude, T., ... Mauri, V. (2024). Impact of Measured and Predicted Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement. JACC: Cardiovascular Interventions, 17(22), 2626-2635. https://doi.org/10.1016/j.jcin.2024.08.041

@article{90f0dccd2c0343d283f4c87d74c9e8ca,

title = "Impact of Measured and Predicted Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement",

abstract = "Background: Prosthesis-patient mismatch after transcatheter aortic valve replacement (TAVR) can be measured echocardiographically (measured prosthesis-patient mismatch [PPMm]) or predicted (predicted prosthesis-patient mismatch [PPMp]) using published effective orifice area (EOA) reference values. However, the clinical implications of PPM post-TAVR remain unclear. Objectives: This study aimed to elucidate the prevalence of PPMm and PPMp post-TAVR and their impact on mortality in a large international cohort. Methods: The IMPPACT TAVR (Impact of Measured or Predicted Prosthesis-pAtient mismatCh after TAVR) registry included 38,808 TAVR patients from 26 international centers. Valve Academic Research Consortium 3 criteria were used to define prosthesis-patient mismatch severity. EOA was determined echocardiographically (PPMm) or predicted (PPMp) based on core lab–derived EOA reference values. The primary endpoint was 2-year all-cause mortality. Results: The prevalence of PPMp (moderate: 6.8\%, severe: 0.6\%) was significantly lower than that of PPMm (moderate: 20.7\%, severe: 4.3\%; P < 0.001) with negligible correlation between the 2 methods (Kendall's tau c correlation coefficient: 0.063; P < 0.001). In unadjusted analyses, severe PPMm adversely influenced 2-year survival (HR: 1.22; 95\% CI: 1.02-1.45; P = 0.027), whereas severe PPMp was not associated with outcomes (HR: 0.81; 95\% CI: 0.55-1.19; P = 0.291). After adjusting for confounders, neither PPMm nor PPMp had a significant effect on 2-year all-cause mortality. Conclusions: PPMm and PPMp were associated with different patient characteristics, with PPMm tending toward worse (especially low flow) and PPMp toward better (especially women) survival. After adjusting for confounders, neither PPMm nor PPMp significantly affected 2-year all-cause mortality. Hence, valve selection should not solely be based on hemodynamics but rather on a holistic approach, including patient and procedural specifics.",

author = "Henning Guthoff and Mohamed Abdel-Wahab and \{the IMPPACT TAVR Investigators\} and Kim, \{Won Keun\} and Guy Witberg and Hendrik Wienemann and Maria Thurow and Jasmin Shamekhi and Clemens Eckel and \{von der Heide\}, Ina and Verena Veulemans and Martin Landt and Marco Barbanti and Ariel Finkelstein and Jury Schewel and \{Van Mieghem\}, Nicolas and Rik Adrichem and Stefan Toggweiler and Tobias Rheude and Luis Nombela-Franco and Amat-Santos, \{Ignacio J.\} and Philipp Ruile and Rodrigo Est{\'e}vez-Loureiro and Matjaz Bunc and Luca Branca and \{De Backer\}, Ole and Giuseppe Tarantini and Darren Mylotte and Dabit Arzamendi and Markus Pauly and Sabine Bleiziffer and Matthias Renker and Baravan Al-Kassou and Helge M{\"o}llmann and Sebastian Ludwig and Tobias Zeus and Corrado Tamburino and Tobias Schmidt and Andreas R{\"u}ck and \{von Stein\}, Philipp and Holger Thiele and Ahmed Abdelhafez and Matti Adam and Stephan Baldus and Tanja Rudolph and Victor Mauri and Johannes Blumstein and Christian Frerker and Salome Hecht and Manuel Hein and Michael Joner and Samuel Lee and Valerie Lohner and Sascha Macherey-Meyer and Meertens, \{Max M.\} and Ute Mons and Costanza Pellegrini and Max Potratz",

note = "Publisher Copyright: {\textcopyright} 2024 The Authors",

year = "2024",

month = nov,

day = "25",

doi = "10.1016/j.jcin.2024.08.041",

language = "English",

volume = "17",

pages = "2626--2635",

journal = "JACC: Cardiovascular Interventions",

issn = "1936-8798",

publisher = "Elsevier Inc.",

number = "22",

}

Guthoff, H, Abdel-Wahab, M, the IMPPACT TAVR Investigators, Kim, WK, Witberg, G, Wienemann, H, Thurow, M, Shamekhi, J, Eckel, C, von der Heide, I, Veulemans, V, Landt, M, Barbanti, M, Finkelstein, A, Schewel, J, Van Mieghem, N , Adrichem, R, Toggweiler, S, Rheude, T, Nombela-Franco, L, Amat-Santos, IJ, Ruile, P, Estévez-Loureiro, R, Bunc, M, Branca, L, De Backer, O, Tarantini, G, Mylotte, D, Arzamendi, D, Pauly, M, Bleiziffer, S, Renker, M, Al-Kassou, B, Möllmann, H, Ludwig, S, Zeus, T, Tamburino, C, Schmidt, T, Rück, A, von Stein, P, Thiele, H, Abdelhafez, A, Adam, M, Baldus, S, Rudolph, T & Mauri, V 2024, 'Impact of Measured and Predicted Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement', JACC: Cardiovascular Interventions, vol. 17, no. 22, pp. 2626-2635. https://doi.org/10.1016/j.jcin.2024.08.041

TY - JOUR

T1 - Impact of Measured and Predicted Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement

AU - Guthoff, Henning

AU - Abdel-Wahab, Mohamed

AU - the IMPPACT TAVR Investigators

AU - Kim, Won Keun

AU - Witberg, Guy

AU - Wienemann, Hendrik

AU - Thurow, Maria

AU - Shamekhi, Jasmin

AU - Eckel, Clemens

AU - von der Heide, Ina

AU - Veulemans, Verena

AU - Landt, Martin

AU - Barbanti, Marco

AU - Finkelstein, Ariel

AU - Schewel, Jury

AU - Van Mieghem, Nicolas

AU - Adrichem, Rik

AU - Toggweiler, Stefan

AU - Rheude, Tobias

AU - Nombela-Franco, Luis

AU - Amat-Santos, Ignacio J.

AU - Ruile, Philipp

AU - Estévez-Loureiro, Rodrigo

AU - Bunc, Matjaz

AU - Branca, Luca

AU - De Backer, Ole

AU - Tarantini, Giuseppe

AU - Mylotte, Darren

AU - Arzamendi, Dabit

AU - Pauly, Markus

AU - Bleiziffer, Sabine

AU - Renker, Matthias

AU - Al-Kassou, Baravan

AU - Möllmann, Helge

AU - Ludwig, Sebastian

AU - Zeus, Tobias

AU - Tamburino, Corrado

AU - Schmidt, Tobias

AU - Rück, Andreas

AU - von Stein, Philipp

AU - Thiele, Holger

AU - Abdelhafez, Ahmed

AU - Adam, Matti

AU - Baldus, Stephan

AU - Rudolph, Tanja

AU - Mauri, Victor

AU - Blumstein, Johannes

AU - Frerker, Christian

AU - Hecht, Salome

AU - Hein, Manuel

AU - Joner, Michael

AU - Lee, Samuel

AU - Lohner, Valerie

AU - Macherey-Meyer, Sascha

AU - Meertens, Max M.

AU - Mons, Ute

AU - Pellegrini, Costanza

AU - Potratz, Max

PY - 2024/11/25

Y1 - 2024/11/25

N2 - Background: Prosthesis-patient mismatch after transcatheter aortic valve replacement (TAVR) can be measured echocardiographically (measured prosthesis-patient mismatch [PPMm]) or predicted (predicted prosthesis-patient mismatch [PPMp]) using published effective orifice area (EOA) reference values. However, the clinical implications of PPM post-TAVR remain unclear. Objectives: This study aimed to elucidate the prevalence of PPMm and PPMp post-TAVR and their impact on mortality in a large international cohort. Methods: The IMPPACT TAVR (Impact of Measured or Predicted Prosthesis-pAtient mismatCh after TAVR) registry included 38,808 TAVR patients from 26 international centers. Valve Academic Research Consortium 3 criteria were used to define prosthesis-patient mismatch severity. EOA was determined echocardiographically (PPMm) or predicted (PPMp) based on core lab–derived EOA reference values. The primary endpoint was 2-year all-cause mortality. Results: The prevalence of PPMp (moderate: 6.8%, severe: 0.6%) was significantly lower than that of PPMm (moderate: 20.7%, severe: 4.3%; P < 0.001) with negligible correlation between the 2 methods (Kendall's tau c correlation coefficient: 0.063; P < 0.001). In unadjusted analyses, severe PPMm adversely influenced 2-year survival (HR: 1.22; 95% CI: 1.02-1.45; P = 0.027), whereas severe PPMp was not associated with outcomes (HR: 0.81; 95% CI: 0.55-1.19; P = 0.291). After adjusting for confounders, neither PPMm nor PPMp had a significant effect on 2-year all-cause mortality. Conclusions: PPMm and PPMp were associated with different patient characteristics, with PPMm tending toward worse (especially low flow) and PPMp toward better (especially women) survival. After adjusting for confounders, neither PPMm nor PPMp significantly affected 2-year all-cause mortality. Hence, valve selection should not solely be based on hemodynamics but rather on a holistic approach, including patient and procedural specifics.

AB - Background: Prosthesis-patient mismatch after transcatheter aortic valve replacement (TAVR) can be measured echocardiographically (measured prosthesis-patient mismatch [PPMm]) or predicted (predicted prosthesis-patient mismatch [PPMp]) using published effective orifice area (EOA) reference values. However, the clinical implications of PPM post-TAVR remain unclear. Objectives: This study aimed to elucidate the prevalence of PPMm and PPMp post-TAVR and their impact on mortality in a large international cohort. Methods: The IMPPACT TAVR (Impact of Measured or Predicted Prosthesis-pAtient mismatCh after TAVR) registry included 38,808 TAVR patients from 26 international centers. Valve Academic Research Consortium 3 criteria were used to define prosthesis-patient mismatch severity. EOA was determined echocardiographically (PPMm) or predicted (PPMp) based on core lab–derived EOA reference values. The primary endpoint was 2-year all-cause mortality. Results: The prevalence of PPMp (moderate: 6.8%, severe: 0.6%) was significantly lower than that of PPMm (moderate: 20.7%, severe: 4.3%; P < 0.001) with negligible correlation between the 2 methods (Kendall's tau c correlation coefficient: 0.063; P < 0.001). In unadjusted analyses, severe PPMm adversely influenced 2-year survival (HR: 1.22; 95% CI: 1.02-1.45; P = 0.027), whereas severe PPMp was not associated with outcomes (HR: 0.81; 95% CI: 0.55-1.19; P = 0.291). After adjusting for confounders, neither PPMm nor PPMp had a significant effect on 2-year all-cause mortality. Conclusions: PPMm and PPMp were associated with different patient characteristics, with PPMm tending toward worse (especially low flow) and PPMp toward better (especially women) survival. After adjusting for confounders, neither PPMm nor PPMp significantly affected 2-year all-cause mortality. Hence, valve selection should not solely be based on hemodynamics but rather on a holistic approach, including patient and procedural specifics.

UR - https://www.scopus.com/pages/publications/85209259316

U2 - 10.1016/j.jcin.2024.08.041

DO - 10.1016/j.jcin.2024.08.041

M3 - Article

C2 - 39603776

AN - SCOPUS:85209259316

SN - 1936-8798

VL - 17

SP - 2626

EP - 2635

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

IS - 22

ER -

Impact of Measured and Predicted Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement

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