Key result
Transcatheter aortic valve replacement was associated with a significantly lower risk of overall prosthesis-patient mismatch compared to surgical aortic valve replacement (OR 0.33).
Why the study?
Does transcatheter aortic valve replacement (TAVR) reduce the incidence of prosthesis-patient mismatch compared to surgical aortic valve replacement (SAVR), and does PPM affect short- and mid-term mortality?
Systematic Review (n=4,691)
Does transcatheter aortic valve replacement (TAVR) reduce the incidence of prosthesis-patient mismatch compared to surgical aortic valve replacement (SAVR), and does PPM affect short- and mid-term mortality?
Odds Ratio: 0.33 (95% CI 0.22–0.51)
p-value: p=<0.001
TAVR is associated with a significantly lower incidence of prosthesis-patient mismatch compared to SAVR, and the presence of PPM after TAVR does not appear to negatively impact short- to mid-term survival.
May guide TAVR selection in mismatch-prone patients; leaves open randomized confirmation.
The aim of this study was to investigate the incidence, predictors and outcome of prosthesis-patient mismatch (PPM) following transcatheter aortic valve replacement (TAVR). A total of 30 articles incorporating 4,691 patients were identified. The pooled incidences of overall, moderate and severe PPM following TAVR were 33.0%, 25.0% and 11.0% respectively. Medtronic CoreValve (MCV) had lower incidence of overall (32% vs: 40%, P < 0.0001) and moderate (23% vs 32%, P < 0.0001) than Edwards Sapien (ESV). PPM was associated with a younger age, smaller annulus diameter and lower left ventricular ejection fraction in comparison with those patients without PPM. Post-dilation (OR, 0.51, 95% CI, 0.38 to 0.68, p < 0.001) during TAVR would decrease the incidence of PPM. Although PPM was common after TAVR, no significant differences were observed both in short- and mid-term all-cause mortality (30 day: OR: 1.1, 95% CI, 0.70 to 1.73 and 2 year: OR: 1.01, 95% CI, 0.74 to 1.38) between patients with PPM and those without PPM. In conclusion, despite being common after TAVR, the incidence of PPM was lower than that of surgical aortic valve replacement (SAVR) and decreased with the experience accumulating, and PPM was not seen to impact on short- and mid-term survival, regardless of its magnitude.
No takes yet. Share an insight, caveat, or question.
Liao et al. (2017) conducted a systematic review in Severe aortic stenosis (n=4,691). Transcatheter Aortic Valve Replacement (TAVR) vs. Surgical Aortic Valve Replacement (SAVR) was evaluated on Incidence of overall prosthesis-patient mismatch (PPM) (OR 0.33, 95% CI 0.22 to 0.51, p=<0.001). Transcatheter aortic valve replacement was associated with a significantly lower risk of overall prosthesis-patient mismatch compared to surgical aortic valve replacement (OR 0.33).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: