Key result
Prosthesis-patient mismatch after TAVI resulted in less KCCQ-12 improvement (+14.6 vs +21.4, p=0.04) without significantly increasing 3-year mortality (24.8% vs 21.1%, HR 1.14, p=0.13).
Why the study?
The clinical relevance of prosthesis-patient mismatch after TAVI and its impact on clinical outcomes and health-related quality of life measures across self-expanding and balloon-expandable transcatheter heart valves remained controversial.
Does prosthesis-patient mismatch after transcatheter aortic valve implantation using self-expanding or balloon-expandable valves impact clinical outcomes and patient-reported health status throughout three years?
Cohort (n=701)
Does prosthesis-patient mismatch after transcatheter aortic valve implantation using self-expanding or balloon-expandable valves impact clinical outcomes and patient-reported health status throughout three years?
Prosthesis-patient mismatch after TAVI occurs more frequently with balloon-expandable than self-expanding valves and is associated with attenuated improvement in patient-reported health status over three years, though it does not significantly impact all-cause mortality.
Background The clinical relevance of prosthesis-patient mismatch (PPM) after transcatheter aortic valve implantation (TAVI) remains controversial. The aim of this study was to compare the frequency of PPM after TAVI using a self-expanding or a balloon-expandable transcatheter heart valve and to investigate the impact of PPM on clinical outcomes and health-related quality of life measures throughout three years. Methods Patients treated in the SCOPE I trial were stratified according to PPM, which was determined by the indexed effective orifice area (EOAi). All patients were stratified according to the EOAi: moderate PPM was defined as 0.66-0.85 cm2/m2 and severe PPM as ≤0.65 cm2/m2. Outcomes of interest included a composite endpoint integrating both vital status and patient-reported, disease-specific health status, as well as clinical endpoints defined according to VARC-3 criteria. Results A total of 701 patients were included. The frequency of any PPM was 41.9% (moderate 29.7% [208/701]; severe 12.3% [86/701]). Any PPM was more frequent with balloon-expandable prosthesis compared with self-expandable prosthesis (53.5% versus 29.9%, p <0.01). Patients with any PPM had less improvement in patient-reported health status after TAVI throughout three years compared to patients with no PPM (improvement of Kansas City Cardiomyopathy Questionnaire 12 Overall Summary score: +14.6 [3.1-32.3] vs. +21.4 [8.3-38.0], p=0.04). The rate of VARC-3 unfavorable outcome was comparable in patients with any and no PPM (16.5% vs. 18.4%, p=0.53). All-cause mortality at three years was not significantly increased in patients with any PPM (24.8% vs. 21.1%, Hazard Ratio 1.14, p=0.13). Conclusions PPM was frequently observed, especially in TAVI patients treated with balloon expandable valves. Patients with any PPM after TAVI had less improvement in patient-reported health status, without impact on all-cause mortality rates during extended follow-up.
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Taniguchi et al. (2026) conducted a cohort in Aortic stenosis treated with transcatheter aortic valve implantation (TAVI) (n=701). Prosthesis-patient mismatch (PPM; EOAi ≤0.85 cm2/m2) vs. No prosthesis-patient mismatch (EOAi >0.85 cm2/m2) was evaluated on All-cause mortality at 3 years (alongside VARC-3 unfavorable outcome and KCCQ-12 score improvement) (HR 1.14, p=0.13). Prosthesis-patient mismatch after TAVI resulted in less KCCQ-12 improvement (+14.6 vs +21.4, p=0.04) without significantly increasing 3-year mortality (24.8% vs 21.1%, HR 1.14, p=0.13).
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