Key result
Prosthesis-patient mismatch after TAVR fails to reduce 5-year survival in women.
Why the study?
Prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR), especially sex-specific differences and impact on long-term survival, remains inadequately characterized.
Does prosthesis-patient mismatch severity and valve type differently impact long-term survival in women versus men undergoing TAVR?
Cohort (n=3,016)
No
Does prosthesis-patient mismatch severity and valve type differently impact long-term survival in women versus men undergoing TAVR?
Despite higher rates of prosthesis-patient mismatch in women following TAVR, long-term survival is not negatively impacted, suggesting that prosthesis selection should balance factors like durability and future coronary access rather than focusing solely on minimizing mismatch.
Background: Prosthesis-patient mismatch (PPM) remains a topic of controversy in patients undergoing transcatheter aortic valve replacement (TAVR), particularly among women with smaller annuli. Although self-expanding valves (SEV) appear to provide superior hemodynamic performance than balloon-expandable valves, the impact of PPM severity on long-term survival, particularly regarding sex-specific differences, remains inadequately characterized. Methods: ) severity as defined by the Valve Academic Research Consortium. The primary outcome was all-cause mortality at 5 years, with secondary outcomes including PPM incidence, severity, and residual transvalvular gradients. Additionally, there was no risk-adjusted survival difference between valve types, emphasizing the need for individualized prosthesis selection and lifetime valve management considerations.
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Al‐Azizi et al. (2025) conducted a cohort in Severe aortic stenosis (n=3,016). Severe predicted prosthesis-patient mismatch vs. No predicted prosthesis-patient mismatch was evaluated on All-cause mortality at 5 years (severe predicted PPM vs no PPM in women) (HR 1.24, 95% CI 0.41-3.75, p=0.709). Although women undergoing transcatheter aortic valve replacement experienced higher rates of prosthesis-patient mismatch than men, it did not significantly reduce their 5-year survival (adjusted HR 1.24 for severe vs no predicted mismatch).
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