February 11, 2026

Five‐Year Outcomes of Measured and Predicted Prosthesis‐Patient Mismatch Following Valve‐in‐Valve Transcatheter Aortic Valve Implantation

Q: What does this research mean for the field?

Neither measured nor predicted prosthesis‐patient mismatch were predictive of 5‐year mortality in patients undergoing valve‐in‐valve TAVI. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Neither measured nor predicted prosthesis-patient mismatch (PPM) predicted 5-year mortality in valve-in-valve TAVI patients, with 5-year mortality ~52%.

Key Points

The aim was to explore the long-term outcomes of measured and predicted prosthesis-patient mismatch in valve-in-valve TAVI.
Conducted a multicenter retrospective analysis of patients who underwent valve-in-valve TAVI.
Measured effective orifice area using transthoracic echocardiography.
Classified prosthesis-patient mismatch using standard and obesity-adjusted effective orifice area values.
Analyzed 162 patients; median age 77 years, with a notable proportion having BMI ≥ 30 kg/m².
Severe predicted prosthesis-patient mismatch incidence was significantly lower than severe measured mismatch incidence.
Five-year mortality rates were similar for both measured and predicted prosthesis-patient mismatch categories.

Structured PICO

Does severe measured or predicted prosthesis-patient mismatch increase 5-year mortality in patients undergoing valve-in-valve TAVI?

Population

162 patients undergoing valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI), median age 77, 64.8% male, median STS risk score 6.3%.

Intervention

Valve-in-valve TAVI with assessment of measured (PPMM) and predicted (PPMP) prosthesis-patient mismatch

Comparator

Absence of severe prosthesis-patient mismatch

Outcome

5-year mortalityhard clinical

Neither measured nor predicted severe prosthesis-patient mismatch was predictive of 5-year mortality in patients undergoing valve-in-valve TAVI.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

ABSTRACT Background This study's objective was to investigate the incidence and long‐term outcomes of measured (PPM M ) and predicted (PPM P ) prosthesis‐patient mismatch in patients undergoing valve‐in‐valve (ViV) transcatheter aortic valve implantation (TAVI). Aims To assess the outcomes of predicted and measured PPM in patients undergoing ViV TAVI. Methods This retrospective, multicenter analysis included patients who underwent ViV TAVI at the Baylor Scott 84.0] years. The median STS risk score was 6.3 3.5; 9.65 %. TAVI was performed trans‐femorally in 95.7%, using balloon‐expandable (52.5%) and self‐expanding (47.5%) devices. The incidence of severe PPMP was significantly lower than that of severe PPMM, both before (14.8% vs. 28.4%, p = 0.005) and after adjusting for BMI (11.1% vs. 24.7%, p = 0.002). Both severe PPMP and PPMM predicted high residual pressure gradient (≥ 20mmHg) ( p = 0.004, p = 0.002, respectively), with no statistical superiority (Delong test, p = 0.82). Five‐year mortality was 52% for PPMM and 51% for PPMP. Severe‐PPMM and severe‐PPMP were not significantly associated to increased mortality when compared to the absence of PPMM (50% vs. 57% survival; HR 1.76, p = 0.221) or PPMP (69% vs. 58% survival; HR 0.81, p = 0.713), respectively. Conclusions In this single healthcare system experience, neither measured PPM nor predicted PPM were predictive of 5‐year mortality in patients undergoing ViV‐TAVI.

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