Severe prosthesis-patient mismatch after TAVI was associated with an increased risk of 1-year mortality (OR 1.109; 95% CI 1.041-1.181; P=0.001), whereas moderate or any PPM was not.
Meta-Analysis (n=71,106)
Does prosthesis-patient mismatch increase 1-year mortality in patients undergoing transcatheter aortic valve implantation?
Severe, but not moderate, prosthesis-patient mismatch after TAVI is associated with a significantly increased risk of 1-year mortality.
Effect estimate: OR 1.021 (95% CI 0.979-1.065)
p-value: p=0.338
OBJECTIVES: This study sought to evaluate the impact of prosthesis-patient mismatch (PPM) on the risk of early-term mortality after transcatheter aortic valve implantation (TAVI). METHODS: Databases (Medical Literature Analysis and Retrieval System Online MEDLINE, Excerpta Medica dataBASE EMBASE, Cochrane Controlled Trials Register CENTRAL/CCTR, ClinicalTrials.gov, Scientific Electronic Library Online SciELO, Latin American and Caribbean Literature on Health Sciences LILACS, and Google Scholar) were searched for studies published until February 2019. PPM after TAVI was defined as moderate if the indexed effective orifice area (iEOA) was between 0.85 cm2/m2 and 0.65 cm2/m2 and as severe if iEOA ≤ 0.65 cm2/m2. RESULTS: The search yielded 1,092 studies for inclusion. Of these, 18 articles were analyzed, and their data extracted. The total number of patients included who underwent TAVI was 71,106. The incidence of PPM after TAVI was 36.3% (25,846 with PPM and 45,260 without PPM). One-year mortality was not increased in patients with any PPM (odds ratio OR 1.021, 95% confidence interval CI 0.979-1.065, P=0.338) neither in those with moderate PPM (OR 0.980, 95% CI 0.933-1.029, P=0.423). Severe PPM was separately associated with high risk (OR 1.109, 95% CI 1.041-1.181, P=0.001). CONCLUSION: The presence of severe PPM after TAVI increased early-term mortality. Although moderate PPM seemed harmless, the findings of this study cannot not rule out the possibility of it being detrimental, since there are other registries that did not address this issue yet.
Sá et al. (Tue,) conducted a meta-analysis in Transcatheter Aortic Valve Implantation (TAVI) (n=71,106). Prosthesis-patient mismatch (PPM) vs. No prosthesis-patient mismatch was evaluated on 1-year mortality for any prosthesis-patient mismatch (OR 1.021, 95% CI 0.979-1.065, p=0.338). Severe prosthesis-patient mismatch after TAVI was associated with an increased risk of 1-year mortality (OR 1.109; 95% CI 1.041-1.181; P=0.001), whereas moderate or any PPM was not.