Five-Year Outcomes of Measured and Predicted Prosthesis-Patient Mismatch following Transcatheter Aortic Valve Implantation

Abstract

BackgroundData on the long-term outcomes of prosthesis-patient mismatch (PPM) after transcatheter aortic valve implantation (TAVI) remain controversial. ObjectivesThe aim of this study was to investigate the incidence and clinical outcomes of measured PPM (PPMM) and predicted PPM (PPMP) in patients undergoing TAVI. MethodsThis is a retrospective analysis of 3,016 patients who underwent TAVI at a large Healthcare System between 2012 and 2021. Effective orifice area indexed to body surface area (EOAi) was measured at discharge using the continuity equation. EOAi was predicted according to the published predictive tables for each model and size of the valve. Primary endpoint was 5-year survival rate. ResultsMean age was 80 years and 55.6% were male. The mean STS risk score was 4.66%. 74.9% of patients received a BEV and 25.1% received a SEV. The incidence of severe PPM was markedly lower when defined by predicted vs. measured EOAi (0.8% vs. 6.3%, P < 0.001) and when assessed in SEV vs. BEV (5.3% vs. 6.6%, p= 0.02). Neither severe PPMp nor severe PPMM was associated with 5-year mortality (HR=1.26, 95% CI= 0.96-1.66, p=0.095; HR=1.03, 95% CI= 0.42-2.49, p=0.954, respectively), irrespective of the presence of high residual pressure gradient. Neither BEV nor SEV was associated with an increased 5-year mortality, irrespective of PPM definition or severity. ConclusionsIn this large healthcare system analysis, neither severe PPMP nor severe PPMM was associated with five-year all-cause mortality. There was no difference between BEV and SEV in terms of mortality, irrespective of the definition or severity of PPM.