What question did this study set out to answer?

To evaluate the prevalence of prosthesis–patient mismatch (PPM) in patients undergoing TAVI and its effects on clinical outcomes.

February 2, 2026

Prevalence and clinical impact of prosthesis patient mismatch after transcatheter aortic valve implantation

Key Result

Prosthesis–patient mismatch occurred in 29.5% of TAVI patients and was linked to increased heart failure admissions (OR 1.52) and all-cause mortality (OR 1.43).

Key Points

To evaluate the prevalence of prosthesis–patient mismatch (PPM) in patients undergoing TAVI and its effects on clinical outcomes.
Retrospective analysis of a single-center cohort of TAVI patients from 2008 to 2023.
Defined PPM using critical effective orifice area (EOA) thresholds based on body mass index.
Utilized regression models to identify predictors related to PPM and clinical outcomes.
29.5% of patients experienced PPM, with 20.7% moderate and 8.9% severe PPM.
Significant predictors of PPM included arterial hypertension, atrial fibrillation, and body surface area.
Patients with PPM had higher aortic gradients and lower left ventricular function, along with increased heart failure-related admissions and mortality risks.

Structured PICO

Does prosthesis-patient mismatch after TAVI increase the risk of adverse clinical events and worse echocardiographic parameters in patients with aortic stenosis?

Population

1,325 patients with aortic stenosis treated with transcatheter aortic valve implantation (TAVI) between 2008 and 2023

Intervention

Presence of prosthesis-patient mismatch (PPM), defined as indexed effective orifice area ≤0.85 cm²/m² (or ≤0.70 cm²/m² if BMI ≥30 kg/m²)

Comparator

Absence of prosthesis-patient mismatch (PPM)

Outcome

Heart failure-related hospital admissions and all-cause mortality during follow-uphard clinical

Prosthesis-patient mismatch after TAVI occurs in nearly 30% of patients and is significantly associated with worse echocardiographic function, increased heart failure hospitalizations, and higher all-cause mortality.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Introduction and Objectives There is ongoing debate regarding the potential clinical implications of prosthesis–patient mismatch (PPM) following transcatheter aortic valve implantation (TAVI). Our aim was to assess the prevalence of PPM in patients undergoing TAVI and its association with post-procedure clinical outcomes, as well as to identify predictors related to the development of PPM. Methods We conducted a retrospective analysis of a prospective single-center cohort of patients treated with TAVI between 2008 and 2023. Regression models were used to identify significant predictors of outcomes. PPM was defined as an indexed effective orifice area (EOA) ≤0.85 cm²/m² (severe if ≤0.65 cm²/m²) and ≤0.70 cm²/m² (severe if ≤0.55 cm²/m²) in patients with a BMI ≥30 kg/m². The EOA was calculated using the continuity equation. Results Out of a total of 1,325 post-TAVI patients, 392 (29.5%) presented with PPM, of whom 274 (20.7%) had moderate PPM and 118 (8.9%) had severe PPM. Variables significantly associated with the presence of PPM included arterial hypertension, atrial fibrillation, body surface area, and EuroSCORE II. Regarding echocardiographic characteristics, patients with better left ventricular (LV) and left atrial (LA) function at baseline showed a lower incidence of PPM (see Table). On follow-up echocardiograms, patients with PPM had higher aortic mean gradients (11.7 vs 8.8 mmHg; p0.001), smaller estimated valve areas (1.22 vs 2.29 cm²; p0.001), lower LV ejection fraction (58.2% vs 60.6%; p0.001), reduced LV strain (-14.9% vs -16.3%; p0.001), more impaired LA strain (16.2% vs 17.8%; p=0.013), and greater indexed LV mass (119 vs 113 g/m²; p=0.039), with no significant differences in right ventricular function. The presence of PPM was associated with an increased risk of heart failure-related hospital admissions during follow-up (OR: 1.52; 95% CI: 1.12–2.04; p=0.005), and all-cause mortality (OR: 1.43; 95% CI: 1.12–1.83; p=0.004) (see Figure). Conclusions In our cohort of patients with aortic stenosis treated with TAVI, the presence of PPM—identified in approximately one-third of the sample—was significantly associated with worse LV and LA function and a higher incidence of adverse clinical events during follow-up. Systematic identification and individualized management of these patients could help improve their prognosis.

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