Key result
Significant post-TAVR PPM in small annuli is linked to BEV use and higher long-term mortality.
Why the study?
Does significant prosthesis-patient mismatch increase long-term mortality in patients with small aortic annuli undergoing transcatheter aortic valve replacement?
Cohort (n=631)
No
Does significant prosthesis-patient mismatch increase long-term mortality in patients with small aortic annuli undergoing transcatheter aortic valve replacement?
Hazard Ratio: 1.97 (95% CI 1.2–3.1)
Absolute Event Rate: 32% vs 25.4%
p-value: p=0.004
In patients with small aortic annuli undergoing TAVR, significant prosthesis-patient mismatch occurs in nearly a quarter of cases and is independently associated with a nearly twofold increase in 5-year mortality.
May favor SEV over BEV in small annuli to reduce PPM; confirms independent long-term mortality risk.
BACKGROUND: Prosthesis-patient mismatch (PPM) remains common following transcatheter aortic valve replacement (TAVR) and is associated with worse clinical outcomes. PPM is of particular concern in small aortic annuli (SAA). AIMS: To compare the incidence, predictors, and long-term impact of PPM in SAA TAVR. METHODS: Single-center retrospective registry analysis of native, severe aortic stenosis patients with computed tomography-derived annulus area ≤ 430 mm², undergoing TAVR via transfemoral access. Significant PPM was defined as moderate and above and classified by the Valve Academic Research Consortium (VARC)-3. Additional analyses were conducted for predicted PPM and gender-based criteria. Inverse probability treatment weighting (IPTW) was applied to identify predictors of significant PPM and long-term mortality. RESULTS: The cohort included 631 consecutive patients with SAA undergoing TAVR between 2015 and 2024. Significant PPM occurred in 23.3%. Multivariable analyses identified BEV implantation (OR 2.1, 95% CI 1.3-4.9, p < 0.001) and larger body surface area (OR 4.6, 95% CI 1.7-18.8, p < 0.001) as independent predictors of PPM. Large annulus perimeter had a protective association (OR 0.85, 95% CI 0.79-0.91, p < 0.001). Five-year mortality was significantly higher among patients with significant PPM (32.0% vs. 25.4%; log-rank p = 0.008). Age (HR 1.04, 95% CI 1.004-1.07, p = 0.03), moderate and above paravalvular leak (HR 3.25, 95% CI 1.3-8.0, p = 0.01), and significant PPM (HR 1.97, 95% CI 1.2-3.1, p = 0.004) were independently associated with 5-year mortality. CONCLUSIONS: Significant PPM remains highly prevalent following SAA TAVR. BEV implantation and larger BSA were associated with significant PPM, and a larger implanted valve had a protective association. Significant PPM is independently associated with long-term mortality.
No takes yet. Share an insight, caveat, or question.
Loewenstein et al. (2026) conducted a cohort in Severe aortic stenosis with small aortic annuli (n=631). Significant prosthesis-patient mismatch (PPM) vs. No significant PPM was evaluated on 5-year mortality (HR 1.97, 95% CI 1.2-3.1, p=0.004). Significant prosthesis-patient mismatch following TAVR in small aortic annuli was independently associated with higher 5-year mortality (32.0% vs. 25.4%; HR 1.97, 95% CI 1.2-3.1; p=0.004).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: