Why the study?
Does severe prosthesis-patient mismatch reduce the likelihood of being alive with good patient-reported health status at 3 years in patients undergoing transcatheter aortic valve replacement?
Cohort (n=662)
Does severe prosthesis-patient mismatch reduce the likelihood of being alive with good patient-reported health status at 3 years in patients undergoing transcatheter aortic valve replacement?
Answers are grounded in this paper and cite their sources.
Severe prosthesis-patient mismatch after TAVR is associated with worse 3-year health status and lower likelihood of survival with good quality of life, although coexisting 30-day residual mitral regurgitation may partially account for this relationship.
BACKGROUND: Prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement has been widely studied for its association with clinical outcomes, but its effect on patient-reported health status remains less defined. OBJECTIVES: This study sought to evaluate the association between PPM severity and health status through 3-year follow-up after transcatheter aortic valve replacement. METHODS: This post hoc analysis of the SCOPE I (Safety and Efficacy of the ACURATE Neo/TF Compared to the SAPIEN 3 Bioprosthesis) randomized trial categorized patients according to PPM severity using Valve Academic Research Consortium-3 criteria. Endpoints included survival and patient-reported health status, with an integrated outcome defined as being alive with good health status (Kansas City Cardiomyopathy Questionnaire Overall Summary score ≥75 without a decline of >10 points from baseline). RESULTS: Among 662 patients, moderate and severe PPM occurred in 184 (27.8%) and 69 (10.4%), respectively. All-cause mortality at 1 and 3 years was 7.0% and 20.5%, with no differences across PPM categories. Kansas City Cardiomyopathy Questionnaire Overall Summary score was similar through 1 year but lower at 3 years in patients with severe vs no PPM (median 71.1 vs 83.9; P = 0.027). Fewer patients with severe PPM were alive with good health status at 3 years (30.6% vs 49.4%; P = 0.021). In multivariable analysis, severe PPM was associated with a lower likelihood of the integrated outcome (OR: 0.51; 95% CI: 0.27-0.96; P = 0.036), but this association was no longer statistically significant after adjustment for 30-day mitral regurgitation (OR: 0.59; 95% CI: 0.30-1.15; P = 0.121). CONCLUSIONS: Among survivors, severe PPM was associated with a lower likelihood of good health status at 3 years. This association was attenuated after accounting for 30-day residual mitral regurgitation, suggesting a possible contributory role. Given the post hoc design, the findings are hypothesis-generating.
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Cozzi et al. (2026) conducted a cohort in Patients undergoing transcatheter aortic valve replacement (TAVR) categorized by prosthesis-patient mismatch (PPM) severity (n=662). Severe prosthesis-patient mismatch (PPM) vs. No prosthesis-patient mismatch (PPM) was evaluated on Integrated outcome of being alive with good health status (KCCQ Overall Summary score ≥75 without a decline of >10 points from baseline) at 3 years (OR 0.51, 95% CI 0.27-0.96, p=0.036).
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