Key result
Post-TAVR prosthesis-patient mismatch is linked to ~2.1-fold higher risk of hemodynamic valve deterioration.
Why the study?
Limited evidence exists regarding the impact of prosthesis-patient mismatch on hemodynamic valve deterioration and bioprosthetic valve failure after transcatheter aortic valve replacement.
Does prosthesis-patient mismatch increase the risk of hemodynamic valve deterioration and bioprosthetic valve failure in patients undergoing transcatheter aortic valve replacement?
Cohort (n=555)
No
Does prosthesis-patient mismatch increase the risk of hemodynamic valve deterioration and bioprosthetic valve failure in patients undergoing transcatheter aortic valve replacement?
Hazard Ratio: 2.1 (95% CI 1.02–4.3)
Absolute Event Rate: 13.6% vs 5.3%
p-value: p=0.04
Prosthesis-patient mismatch after TAVR is significantly associated with an over two-fold increased risk of hemodynamic valve deterioration and an over four-fold increased risk of bioprosthetic valve failure, emphasizing the importance of pre-procedural planning and sizing.
Prosthesis-patient mismatch after TAVR was associated with higher deterioration and failure risks; leaves open whether avoidance improves durability.
Background: Prosthesis-patient mismatch (PPM) is associated with structural valve deterioration after surgical aortic valve replacement. Limited evidence exists regarding its impact on hemodynamic valve deterioration (HVD) and bioprosthetic valve failure (BVF) following transcatheter aortic valve replacement (TAVR). Methods: Patients who underwent TAVR from 2013 to 2022 at UC San Diego Health with echocardiographic follow-up were retrospectively analyzed. PPM, determined by measured indexed effective orifice area, and outcomes of moderate or severe HVD and BVF were defined per Valve Academic Research Consortium 3 guidelines. Fine and Gray regression, with all-cause death as a competing risk, was used to compare the cumulative incidence of outcomes in patients with and without PPM. Results: = 0.03). Conclusions: In this single-center cohort, PPM was associated with an over two-fold increased risk of moderate or severe HVD and an over four-fold increased risk of BVF following TAVR, emphasizing the importance of pre-implant prevention.
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Sampath-Kumar et al. (2025) conducted a cohort in Severe aortic stenosis undergoing TAVR (n=555). Prosthesis-patient mismatch vs. No prosthesis-patient mismatch was evaluated on Moderate or severe hemodynamic valve deterioration (HVD) (adjusted HR 2.10, 95% CI 1.02-4.30, p=0.04). Prosthesis-patient mismatch following TAVR independently increased the risk of moderate or severe hemodynamic valve deterioration (aHR 2.10) and bioprosthetic valve failure (aHR 4.32).
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