Prevalence, predictors, and outcomes of patient prosthesis mismatch in women undergoing TAVI for severe aortic stenosis: Insights from the WIN-TAVI registry

WIN-TAVI Investigators, Vasileios F. Panoulas*, Jaya Chandrasekhar, Gherardo Busi, Neil Ruparelia, Zhongjie Zhang, Julinda Mehilli, Samantha Sartori, Thierre Lefèvre, Patrizia Presbitero, Piera Capranzano, Didier Tchetche, Alessandro Iadanza, Gennaro Sardella, Nicolas M. Van Mieghem, Emanuele Meliga, Nicolas Dumonteil, Chiara Fraccaro, Daniela Trabattoni, Samin SharmaMaria Cruz Ferrer-Gracia, Christoph K. Naber, Peter C. Kievit, Clayton Snyder, Nilesh Sutaria, Sayan Sen, Iqbal S. Malik, Marie Claude Morice, Petros Nihoyannopoulos, Anna Sonia Petronio, Roxana Mehran, Alaide Chieffo, Ghada W. Mikhail

*Corresponding author for this work

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Abstract

Objective: To evaluate the incidence, predictors and outcomes of female patients with patient-prosthesis mismatch (PPM) following transcatheter aortic valve intervention (TAVI) for severe aortic stenosis (AS).

Background: Female AS TAVI recipients have a significantly lower mortality than surgical aortic valve replacement (SAVR) recipients, which could be attributed to the potentially lower PPM rates. TAVI has been associated with lower rates of PPM compared to SAVR. PPM in females post TAVI has not been investigated to date.

Methods: The WIN-TAVI (Women's INternational Transcatheter Aortic Valve Implantation) registry is a multicenter registry of women undergoing TAVR for severe symptomatic AS. Two hundred and fifty patients with detailed periprocedural and follow-up echocardiographic investigations were included in the WIN-TAVI echocardiographic sub-study. PPM was defined as per European guidelines stratified by the presence of obesity.

Results: The incidence of PPM in our population was 32.8%. Patients with PPM had significantly higher BMI (27.4 ± 6.1 vs. 25.2 ± 5.0, p =.002), smaller sized valves implanted (percentage of TAVI ≤23 mm 61% vs. 29.2%, PPM vs. no PPM, p <.001) and were more often treated with balloon expandable valves (48.3 vs. 32.5%, p <.001) rather than self expanding ones (26.3 vs. 52.8%, <.001). BMI (OR = 1.08; 95%CI 1.02–1.14, p =.011) and valve size ≤23 mm (OR = 3.00 95%CI 1.14–7.94, p =.027) were the only independent predictors of PPM. There was no significant interaction between valve size and valve type (p =.203). No significant differences were observed in 1-year mortality or major adverse cardiovascular events.

Conclusions: PPM in females undergoing TAVI occurs in one third of patients. BMI and valve size ≤23 mm are independent predictors. Larger registries are required to determine the impact of PPM on future clinical outcomes.

Original languageEnglish
Pages (from-to)516-526
Number of pages11
JournalCatheterization and Cardiovascular Interventions
Volume97
Issue number3
Early online date31 Aug 2020
DOIs
Publication statusPublished - 15 Feb 2021

Bibliographical note

Funding Information:
Dr. P. P. has served as a consultant for Boston Scientific, Medtronic, and Abbott Vascular. Dr. J. M. has received lecture fees from Edwards Lifesciences, Abbott, Vascular, Biotronik, Lilly/Daiichi‐Sankyo, Terumo, and Bristol‐Myers Squibb; and institutional research grant support from Abbott Vascular and Edwards Lifesciences. Dr. T. L. has served as a proctor for Edwards Lifesciences. Dr. V. F. P. has served as a proctor for Medtronic. Dr. G. S. has received proctor fees for Edwards Lifesciences; and speaker fees from Direct Flow. Dr. N. M. M. has received research grant support from Boston Scientific, Edwards Lifesciences, Medtronic, St. Jude Medical, Abbott Vascular, and Claret Medical. Dr. N. D. has received proctor fees from Edwards Lifesciences, Medtronic, Boston Scientific, and Abbott Vascular. Dr. Mikhail is the director of the Imperial Valve and Cardiovascular Course. Dr. S. S. has served on the Speakers Bureau for Boston Scientific, Abbott Vascular, Cardiovascular Systems Inc., and TriReme. Dr. C. F. N. has received speaker fees from Edwards Lifesciences, Direct Flow Medical, Medtronic, and Claret; is a minor shareholder with Claret; and has served as an advisor for Direct Flow Medical. Dr. R. M. has received institutional research grant support from Eli Lilly/Daiichi‐Sankyo Inc., AstraZeneca, The Medicines Company, Bristol‐Myers Squibb, OrbusNeich, Beth Israel Deaconess, and Bayer; has served as a consultant for Boston Scientific, Cardiovascular Systems Inc., Medscape, and Shanghai BraccoSine Pharmaceutical; has received institutional advisory board funding from Bristol‐Myers Squibb; has received institutional funding from Claret Medical; owns equity in Claret Medical and Elixir Medical; has served on the executive committee for Janssen Pharmaceuticals and Osprey Medical; has served on the data safety monitoring board for Watermark Research Partners; and has a spouse who has served as a consultant for Abiomed and the Medicines Company. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Funding Information:
The authors would like to thank the Society for Cardiovascular Angiography and Interventions for supporting the launch of this study.

Publisher Copyright:
© 2020 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.

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