Key result
Neither measured nor predicted moderate-to-severe prosthesis-patient mismatch was associated with all-cause mortality in the overall cohort of patients with bicuspid aortic valves undergoing TAVR.
Why the study?
Evidence regarding measured and predicted prosthesis-patient mismatch after transcatheter aortic valve replacement in bicuspid aortic valve stenosis remains limited.
Does measured or predicted prosthesis-patient mismatch after TAVR affect survival in patients with Sievers type 1 bicuspid aortic valve?
Observational (n=781)
Yes
Does measured or predicted prosthesis-patient mismatch after TAVR affect survival in patients with Sievers type 1 bicuspid aortic valve?
In patients with Sievers type 1 bicuspid aortic valve undergoing TAVR, predicted prosthesis-patient mismatch occurs less frequently than measured mismatch, and neither significantly impacts survival in the overall cohort, though predicted mismatch may be detrimental in patients with small annuli.
Answers are grounded in this paper and cite their sources.
Does not support altering TAVR decisions for bicuspid valves based on mismatch; leaves open potential risks in small annuli for further study.
BACKGROUND: Evidence regarding prosthesis-patient mismatch (PPM), measured (mPPM), and predicted (pPPM), after transcatheter aortic valve replacement in bicuspid aortic valve stenosis remains limited. This study sought to evaluate the incidence, predictors, and prognostic implications of mPPM and pPPM in patients with Sievers type 1 bicuspid aortic valve undergoing transcatheter aortic valve replacement. METHODS: The AD-HOC registry is a retrospective, multicenter study including 781 patients with severe aortic stenosis and bicuspid aortic valve treated with transcatheter aortic valve replacement between 2016 and 2023 across 24 centers. PPM was defined according to Valve Academic Research Consortium-3 criteria. The primary outcome was all-cause mortality. CONCLUSIONS: In patients with Sievers type 1 bicuspid aortic valve undergoing transcatheter aortic valve replacement, pPPM occurred less frequently than mPPM and was predominantly driven by anatomic characteristics and sizing strategies. Although pPPM was associated with increased all-cause mortality among patients with small annuli, this association did not extend to cardiovascular mortality and should be considered hypothesis-generating. Further prospective investigations are warranted to better delineate the impact of anatomic constraints on clinical outcomes in this anatomically challenging subset.
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Fabris et al. (2026) conducted an observational in Severe aortic stenosis with Sievers type 1 bicuspid aortic valve (n=781). Measured and predicted prosthesis-patient mismatch (mPPM and pPPM) vs. No moderate-to-severe prosthesis-patient mismatch was evaluated on All-cause mortality at longest available follow-up. Neither measured nor predicted moderate-to-severe prosthesis-patient mismatch was associated with all-cause mortality in the overall cohort of patients with bicuspid aortic valves undergoing TAVR.
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