Key result
TAVR may prevent PPM better than SAVR, particularly in patients with small aortic annuli.
Why the study?
Does TAVR prevent prosthesis-patient mismatch better than SAVR in patients undergoing aortic valve replacement?
Does TAVR prevent prosthesis-patient mismatch better than SAVR in patients undergoing aortic valve replacement?
TAVR may be a superior strategy to SAVR for preventing prosthesis-patient mismatch in patients with a small aortic annulus, though more randomized data is needed.
May favor TAVR over SAVR in small annuli to reduce mismatch; leaves open need for randomized confirmation.
Prosthesis-patient mismatch (PPM) is frequent following surgical aortic valve replacement (SAVR) and is associated with an increased risk of morbidity and mortality. Preventive strategies to avoid or minimise PPM should be implemented in patients who are at high risk (i.e., patients with a small aortic annulus or those undergoing a valve-in-valve procedure within a small surgical bioprosthesis) and/or vulnerable to PPM (i.e., depressed left ventricular [LV] systolic function, severe LV hypertrophy, concomitant mitral regurgitation, and paradoxical low-flow, low-gradient aortic stenosis). Recent studies suggest that transcatheter aortic valve replacement (TAVR) may be superior to SAVR for the prevention of PPM and associated adverse cardiac events, particularly in the subset of patients with a small (<21 mm) aortic annulus. However, further randomised studies are needed to confirm the potential superiority of TAVR for this purpose.
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Pîbarot et al. (2015) conducted a review in Prosthesis-patient mismatch following aortic valve replacement. Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on Prosthesis-patient mismatch (PPM) and associated adverse cardiac events. Transcatheter aortic valve replacement may be superior to surgical aortic valve replacement for preventing prosthesis-patient mismatch, particularly in patients with a small (<21 mm) aortic annulus.
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