Prosthesis-patient mismatch after transcatheter implantation of contemporary balloon-expandable and self-expandable valves in small aortic annuli

Pier Pasquale Leone, Damiano Regazzoli*, Matteo Pagnesi, Giuliano Costa, Rui Teles, Marianna Adamo, Maurizio Taramasso, Federico De Marco, Antonio Mangieri, Faraj Kargoli, Yohei Ohno, Francesco Saia, Alfonso Ielasi, Flavio Ribichini, Diego Maffeo, Won Keun Kim, Francesco Maisano, Nicolas M. Van Mieghem, Antonio Colombo, Bernhard ReimersAzeem Latib*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

9 Citations (Scopus)
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Abstract

Background: 

Evidence of clinical impact of PPM after TAVI is conflicting and might vary according to the type of valve implanted. 

Aims: 

To assess the clinical impact of prosthesis-patient mismatch (PPM) after transcatheter aortic valve implantation (TAVI) with balloon-expandable (BEV) and self-expandable valves (SEV) in patients with small annuli. 

Methods: 

TAVI-SMALL 2 enrolled 628 patients in an international retrospective registry, which included patients with severe aortic stenosis and small annuli (annular perimeter <72 mm or area <400 mm2) treated with transfemoral TAVI at 16 high-volume centers between 2011 and 2020. Analyses were performed comparing patients with less than moderate (n = 452), moderate (n = 138), and severe PPM (n = 38). Primary endpoint was incidence of all-cause mortality. Predictors of all-cause mortality and PPM were investigated. 

Results: 

At a median follow-up of 380 days (interquartile range: 210–709 days), patients with severe PPM, but not moderate PPM, had an increased risk of all-cause mortality when compared with less than moderate PPM (log-rank p = 0.046). Severe PPM predicted all-cause mortality in patients with BEV (hazard ratio [HR]: 5.20, 95% confidence interval [CI]: 1.27–21.2) and intra-annular valves (IAVs, HR: 4.23, 95% CI: 1.28–14.02), and it did so with borderline significance in the overall population (HR: 2.89, 95% CI: 0.95–8.79). Supra-annular valve (SAV) implantation was the only predictor of severe PPM (odds ratio: 0.33, 95% CI: 0.13–0.83). 

Conclusions: 

Patients with small aortic annuli and severe PPM after TAVI have an increased risk of all-cause mortality at early term follow-up, especially after IAV or BEV implantation. TAVI with SAV protected from severe PPM.

Original languageEnglish
Pages (from-to)931-943
Number of pages13
JournalCatheterization and Cardiovascular Interventions
Volume102
Issue number5
Early online date5 Sept 2023
DOIs
Publication statusPublished - 1 Nov 2023

Bibliographical note

Publisher Copyright:
© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.

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