Severe prosthesis-patient mismatch occurred in 12% of patients undergoing TAVR and was associated with higher 1-year mortality (17.2% vs 15.9% for no PPM; p=0.02) and HF rehospitalization.
Cohort (n=62,125)
Yes
Absolute Event Rate: 17.2% vs 15.9%
p-value: p=0.02
BACKGROUND Prosthesis-patient mismatch (PPM) after surgical aortic valve replacement (AVR) for aortic stenosis is generally associated with worse outcomes. Transcatheter AVR (TAVR) can achieve a larger valve orifice and the effects of PPM after TAVR are less well studied. OBJECTIVES The authors utilized the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) registry to examine the frequency, predictors, and association with outcomes of PPM after TAVR in 62,125 patients enrolled between 2014 and 2017. METHODS On the basis of the discharge echocardiographic effective valve area indexed to body surface area, PPM was classified as severe (0.85 cm2/m2). Multivariable regression models were utilized to examine predictors of severe PPM as well as adjusted outcomes, including mortality, heart failure (HF) rehospitalization, stroke, and quality of life, at 1 year in 37,470 Medicare patients with claims linkage. RESULTS Severe and moderate PPM were present following TAVR in 12% and 25% of patients, respectively. Predictors of severe PPM included small (≤23-mm diameter) valve prosthesis, valve-in-valve procedure, larger body surface area, female sex, younger age, non-white/Hispanic race, lower ejection fraction, atrial fibrillation, and severe mitral or tricuspid regurgitation. At 1 year, mortality was 17.2%, 15.6%, and 15.9% in severe, moderate, and no PPM patients, respectively (p = 0.02). HF rehospitalization had occurred in 14.7%, 12.8%, and 11.9% of patients with severe, moderate, and no PPM, respectively (p < 0.0001). There was no association of severe PPM with stroke or quality-of-life score at 1 year. CONCLUSIONS Severe PPM after TAVR was present in 12% of patients and was associated with higher mortality and HF rehospitalization at 1 year. Further investigation is warranted into the prevention of severe PPM in patients undergoing TAVR.
“This is an important contemporary snapshot of what's happening in the real world with commercial TAVR procedures. This is the first study that is large enough to demonstrate meaningful data associated with PPM for a relatively new procedure like TAVR. Based on these findings, prosthesis-patient mismatch (PPM) is an important problem in this population, one that deserves greater awareness among operators. And being aware of it is the first step in trying to prevent it.”
Herrmann et al. (Sun,) conducted a cohort in Aortic stenosis (n=62,125). Severe prosthesis-patient mismatch vs. No prosthesis-patient mismatch was evaluated on Mortality at 1 year (p=0.02). Severe prosthesis-patient mismatch occurred in 12% of patients undergoing TAVR and was associated with higher 1-year mortality (17.2% vs 15.9% for no PPM; p=0.02) and HF rehospitalization.