Flow Status-Based Predicted Prosthesis-Patient Mismatch in Patients Undergoing Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Severe, symptomatic aortic stenosis (n=1510). Intervention: Moderate or severe flow status-based predicted prosthesis-patient mismatch vs. No prosthesis-patient mismatch. Primary outcome: All-cause mortality at 5 years (HR 0.99, 95% CI 0.77-1.28, p=0.956).

Q: What does this research mean for the field?

Five-year mortality and adverse event rates are comparable in patients with and without flow status-based predicted prosthesis-patient mismatch following transcatheter aortic valve replacement. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Daijiro Tomii; Dik Heg; Masaaki Nakase; Daryoush Samim; Jonas Lanz; Fabien Praz; Stefan Stortecky; David Reineke; Stephan Windecker; Thomas Pilgrim

doi:10.1016/j.shj.2024.100379

December 6, 2024Structural HeartOpen Access

Flow Status-Based Predicted Prosthesis-Patient Mismatch in Patients Undergoing Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve

View Full Paper

Ask AI

Bookmark

Share

Key result

Flow-adjusted predicted PPM is not associated with increased 5-year mortality after TAVR.

Figures

Why the study?

Established methods for assessing predicted PPM do not consider flow status, potentially underestimating the rate and impact of PPM in patients with abnormal flow status.

Does flow status-based predicted prosthesis-patient mismatch increase the risk of adverse clinical outcomes in patients undergoing TAVR with balloon-expandable valves?

Study Design

Type

Cohort (n=1,510)

Multicenter

No

Structured PICO

Does flow status-based predicted prosthesis-patient mismatch increase the risk of adverse clinical outcomes in patients undergoing TAVR with balloon-expandable valves?

P

Population

1,510 patients with severe, symptomatic aortic stenosis undergoing TAVR with balloon-expandable devices, followed for up to 5 years.

E

Exposure

Moderate or severe flow status-based predicted prosthesis-patient mismatch (PPM), defined by predicted effective orifice area (EOA) adjusted for post-TAVR flow status.

C

Comparator

No flow status-based predicted prosthesis-patient mismatch (PPM).

O

Outcome

All-cause mortality, cardiovascular mortality, structural valve deterioration, and unplanned repeat aortic valve intervention at 1 and 5 years after TAVR.hard clinical

Main Result

Hazard Ratio: 0.99 (95% CI 0.77–1.28)

Absolute Event Rate: 46.9% vs 50.5%

p-value: p=0.956

Flow status-based predicted prosthesis-patient mismatch does not significantly increase the risk of mortality or structural valve deterioration up to 5 years after TAVR with balloon-expandable valves.

Limitations

Modest number of eligible patients
Flexible range of device expansion resulting in various actual EOA
Predicted EOA CT ignores changes in aortic root dimensions after TAVR

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Flow status-based predicted PPM showed no mortality link after TAVR; leaves open whether it refines risk stratification versus standard EOA methods.

Abstract

Background: Effective orifice area (EOA) is flow dependent. However, established methods for the assessment of predicted prosthesis-patient mismatch (PPM) do not consider flow status and therefore may underestimate the rate and impact of PPM in patients with abnormal flow status. This study aimed to investigate the clinical impact of flow status-based predicted PPM in patients undergoing transcatheter aortic valve replacement (TAVR). Methods: ). Five-year mortality was comparable in patients with and without flow status-based predicted PPM defined by either method. These results were consistent when patients were stratified by flow status. Conclusions: Rates of PPM differ considerably when flow status is considered. There was no consistent signal of increased risk of adverse events up to 5 years in patients with flow status-based predicted PPM. Clinical Trial Registration: https://www.clinicaltrials.gov. NCT01368250.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Tomii et al. (2024) conducted a cohort in Severe, symptomatic aortic stenosis (n=1,510). Moderate or severe flow status-based predicted prosthesis-patient mismatch vs. No prosthesis-patient mismatch was evaluated on All-cause mortality at 5 years (HR 0.99, 95% CI 0.77-1.28, p=0.956). Moderate or severe flow status-based predicted prosthesis-patient mismatch was not associated with an increased risk of 5-year all-cause mortality (HR 0.99) compared to no mismatch in patients undergoing TAVR.

synapsesocial.com/papers/6a1941afac919e0a4888d49a https://doi.org/10.1016/j.shj.2024.100379

View Full Paper

Ask AI

Bookmark

Share

Flow Status-Based Predicted Prosthesis-Patient Mismatch in Patients Undergoing Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Flow Status-Based Predicted Prosthesis-Patient Mismatch in Patients Undergoing Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading