Key result
TAVR lowers prosthesis-patient mismatch ~69% versus SAVR without impacting mid-term survival.
Why the study?
Prosthesis-patient mismatch following TAVR is common, but its incidence, predictors, and outcome remain controversial.
Does transcatheter aortic valve replacement reduce the incidence of prosthesis-patient mismatch compared to surgical aortic valve replacement, and does prosthesis-patient mismatch impact short- and mid-term mortality?
Meta-Analysis (n=72,016)
Does transcatheter aortic valve replacement reduce the incidence of prosthesis-patient mismatch compared to surgical aortic valve replacement, and does prosthesis-patient mismatch impact short- and mid-term mortality?
Effect estimate: OR 0.31 (95% CI 0.20-0.50)
TAVR is associated with a significantly lower risk of prosthesis-patient mismatch compared to SAVR, and the presence of mismatch after TAVR does not appear to negatively impact short- to mid-term survival.
TAVR reduces PPM versus SAVR without mid-term survival benefit; confirms lower PPM incidence yet questions its prognostic relevance.
BACKGROUND: Prosthesis-patient mismatch (PPM) following transcatheter aortic valve replacement (TAVR) is common, but the incidence, predictors and outcome of PPM are still controversial. METHODS: A total of 18 articles incorporating 72,016 patients were identified form PubMed and Embase online database. RESULTS: The pooled incidences of overall, and severe PPM following TAVR were 32.0% and 10.0% separately. Comparing to surgical aortic valve replacement (SAVR), TAVR had lower incidence of overall (OR, 0.31, 95% CI, 0.20-0.50) and severe PPM (OR, 0.38, 95% CI, 0.28-0.52). PPM was associated with a larger body surface area (BSA), larger body mass index (BMI) and previous myocardial infarction in comparison with those patients without PPM. Although PPM was not rare after TAVR, no significant differences were observed both in short- and mid-term all-cause mortality (30 day: OR: 1.51, 95% CI, 0.79-2.87, 1 year: OR: 1.02, 95% CI, 0.96-1.08, and 2 years: OR: 0.99, 95% CI, 0.79-1.24) between patients with PPM and those without PPM. CONCLUSIONS: Despite the fact that the incidence of PPM was lower than that of SAVR, PPM was not seen to have an impact on short- and mid-term survival.
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He et al. (2020) conducted a meta-analysis in Prosthesis-patient mismatch after transcatheter aortic valve replacement (n=72,016). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on Overall prosthesis-patient mismatch (PPM) (OR 0.31, 95% CI 0.20-0.50). Transcatheter aortic valve replacement had a lower incidence of overall prosthesis-patient mismatch compared to surgical replacement (OR 0.31; 95% CI 0.20-0.50), which did not impact mid-term survival.
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