Abstract
The aim of this study was to assess the outcomes of severe prosthesis-patient mismatch (PPM) in the TVT (Transcatheter Valve Therapy) Registry in patients undergoing supra-annular transcatheter aortic valve replacement (TAVR) for de novo stenosis or failed surgical bioprostheses (transcatheter aortic valve [TAV]-in-surgical aortic valve [SAV]). Severe PPM has been associated with adverse outcomes following TAVR, yet the clinical outcome of severe PPM after supra-annular TAVR is largely unknown. Supra-annular TAVR was performed in patients enrolled in the TVT Registry with de novo stenosis (n=42,174) or TAV-in-SAV (n=5,446). Valve Academic Research Consortium-3 criteria were used to define severe PPM. The clinical impact of severe PPM on 1-year mortality and valve-related readmission was assessed using multivariate regression. A generalized linear mixed model was used to evaluate predictors of severe PPM. Severe PPM was found in 5.3% of patients undergoing de novo TAVR and 27.0% of patients undergoing TAV-in-SAV. The presence of severe PPM was not significantly associated with 1-year mortality or valve-related readmissions in both groups. Mean aortic gradients were higher in patients with severe PPM than in those without severe PPM at 1month (9.7 ± 5.7mmHg vs. 7.3 ± 4.0mmHg; p<0.001) and 1 year (10.2 ± 6.4mmHg vs. 8.0 ± 4.3mmHg; p<0.001). Pre-procedural factors, including a<20-mm aortic annulus, were positive predictors of severe PPM in patients undergoing de novo TAVR (area under the curve=0.795) and TAV-in-SAV (area under the curve=0.764). Severe PPM after supra-annular TAVR was not associated with increased 1-year mortality or valve-related readmissions. Longer-term follow-up is needed to determine if higher residual gradients in patients with severe PPM predict long-term outcomes. (STS/ACC Transcatheter Valve Therapy Registry [TVT Registry]; NCT01737528).
Published Version
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