Incidence, Predictors and Outcome of Prosthesis-Patient Mismatch after Transcatheter Aortic Valve Replacement: a Systematic Review and Meta-analysis

Yan-Biao Liao,Jiay-Yu Tsauo,Yi-Jian Li,Mao Chen,Li Jun-Li,Tian-Yuan Xiong,Xin Wei,Zhen-Gang Zhao,Yuan Feng,Yuan-Ning Xu

doi:10.1038/s41598-017-15396-4

Abstract

The aim of this study was to investigate the incidence, predictors and outcome of prosthesis-patient mismatch (PPM) following transcatheter aortic valve replacement (TAVR). A total of 30 articles incorporating 4,691 patients were identified. The pooled incidences of overall, moderate and severe PPM following TAVR were 33.0%, 25.0% and 11.0% respectively. Medtronic CoreValve (MCV) had lower incidence of overall (32% vs: 40%, P < 0.0001) and moderate (23% vs 32%, P < 0.0001) than Edwards Sapien (ESV). PPM was associated with a younger age, smaller annulus diameter and lower left ventricular ejection fraction in comparison with those patients without PPM. Post-dilation (OR, 0.51, 95% CI, 0.38 to 0.68, p < 0.001) during TAVR would decrease the incidence of PPM. Although PPM was common after TAVR, no significant differences were observed both in short- and mid-term all-cause mortality (30 day: OR: 1.1, 95% CI, 0.70 to 1.73 and 2 year: OR: 1.01, 95% CI, 0.74 to 1.38) between patients with PPM and those without PPM. In conclusion, despite being common after TAVR, the incidence of PPM was lower than that of surgical aortic valve replacement (SAVR) and decreased with the experience accumulating, and PPM was not seen to impact on short- and mid-term survival, regardless of its magnitude.

Highlights

Prosthesis-patient mismatch (PPM) is present when the prosthetic valve is too small in relation to body size and was first described by Rahimtoola[1]
We found that patients with moderate and severe prosthesis-patient mismatch (PPM) were not associated with higher risk of 1-year and 2-year all-cause mortality respectively in comparison with that of PPM (Table 2)
The main results of the present meta-analysis and systematic review were: 1) more than thirty percent of patients underwent transcatheter aortic valve replacement (TAVR) may encounter PPM; 2) Medtronic CoreValve (MCV) had lower prevalence of overall and moderate PPM than Edwards Sapien valve (ESV); 3) TAVR was associated with reduced risk for the incidence of overall, moderate and severe PPM in comparison with surgical aortic valve replacement (SAVR); 4) baseline larger body mass index (BMI), smaller aortic annulus diameters, lower left ventricular ejection fraction (LVEF) and smaller baseline EOA were associated higher risk for PPM; 5) post-dilation during TAVR was associated with reduced risk for PPM; 6) compared with No-PPM, PPM was not associated with higher short- and mid-term all-cause mortality, regardless of its magnitude

Summary

Introduction

Prosthesis-patient mismatch (PPM) is present when the prosthetic valve is too small in relation to body size and was first described by Rahimtoola[1]. Several studies have reported that the prevalence of PPM after surgical aortic valve replacement (SAVR) ranged from 20% to 70%2, and the higher pressure gradients observed in PPM3 results in reduced reverse remodeling[4]. Two recent meta-analysis reported that moderate and severe PPM after SAVR was associated with higher overall mortality[5,6]. Increasing evidence demonstrated TAVR have comparable results in patients with intermediate surgical risk, compared to SAVR7,8. The incidence and outcome of PPM after TAVR is concerned when TAVR extended to patients with intermediate surgical risk. Controversial has intensified on the incidence, predictors and outcome of PPM after TAVR9–11. We performed a systematic review and meta-analysis to comprehensively and quantitatively investigate the incidence, predictors, preventive approaches and outcome of PPM

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Discussion

Conclusion