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 language | English |
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Pages (from-to) | 931-943 |
Number of pages | 13 |
Journal | Catheterization and Cardiovascular Interventions |
Volume | 102 |
Issue number | 5 |
Early online date | 5 Sept 2023 |
DOIs | |
Publication status | Published - 1 Nov 2023 |
Bibliographical note
Publisher Copyright:© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.