A077 Incidence, Predictors and Prognostic Impact of Patient-Prosthesis Mismatch Following Transcatheter Aortic Valve Implantation

Abstract

Patient-prosthesis mismatch (PPM) describes a state where the effective orifice area (EOA) of a valve prosthesis is too small relative to the patient's body surface area (BSA). We reviewed the incidence and prognostic impact of PPM following transcatheter aortic valve implantation (TAVI). A retrospective review of patients undergoing TAVI in the Auckland Region between October 2011 and December 2018 was performed. PPM was classified as severe (<0.65 cm2/m2), moderate (0.65-0.85 cm2/m2), or none (>0.85 cm2/m2) on post-TAVI echocardiography. Multivariable logistic regression analysis was used to determine independent predictors of PPM. One-year clinical outcomes were analysed. A total of 294 patients were included in this study (median age 81 years, interquartile range [IQR] 76 to 85 years], BSA 1.87m2, IQR 1.69 to 2.05m2). SAPIEN XT or S3 valves were used in 239 patients (81.3%) and 24 (8.2%) had valve-in-valve TAVI. Moderate and severe PPM were observed following TAVI in 42 (14.3%) and 26 (8.8%) patients respectively. In our multivariate analysis, larger BSA, smaller left ventricular outflow tract (LVOT) diameter and valve-in-valve procedures were identified as independent predictors of severe PPM. There was no significant difference in 30 day or 1-year mortality between PPM groups. Larger BSA, smaller LVOT diameter and valve-in-valve TAVI were predictors of moderate or severe PPM. PPM did not have a significant prognostic impact on mortality following TAVI, consistent with larger international registries.