Prosthesis patient mismatch is an independent predictor of congestive heart failure after transcatheter aortic valve replacement

Abstract

Little is known about the impact of prosthesis-patient mismatch (PPM) on outcomes after trans-catheter aortic valve replacement (TAVR). We reported previously an increased risk of PPM with Sapien 3 transcatheter Heart valve (S3-THV). We aimed to investigate the one-year outcomes of patients operated on for severe aortic stenosis (AS) with S3-THV based on the occurrence of PPM. Indexed effective orifice area (iEOA) was estimated by post-procedural echocardiography(TTE). PPM was defined as moderate when 0.65 cm 2 ≤ Ieoa ≤ 0.85 cm 2 , or severe if iEOA < 0.65 cm 2 /m 2 . Inclusion criteria: severe symptomatic AS implanted with S3-THV. Primary endpoint: one-year overall mortality secondary endpoint: hospitalization for congestive heart failure (CHF). A total of 227 consecutives patients were included between January 2015 and December 2016. Of the 208 patients with complete follow-up, mean age was 81.9 ± 6, mean Euroscore2 was 4.35 ± 3.4, mean baseline LVEF was 58 ± 13%. At post-procedural TTE, moderate and severe PPM were observed in 69 (33%) and 10 (4.8%) patients respectively. Patients with PPM were younger (80.4 ± 7 vs. 82.9 ± 5, P = 0.007), had a larger body surface area (1.84 ± 0.19 vs. 1.77 ± 0.19, P = 0.01), a lower iEAO (0.73 ± 0.1 vs. 1.1 ± 0.2, P < 0.001) and a higher mean gradient (12 ± 4 vs. 14 ± 5 mmHg, P < 0.001). At 1 year, the estimated overall mortality was similar between the PPM and non PPM groups (5.1% vs. 5.4%, P = 0.97); the PPM group had a significantly higher incidence of CHF at one year follow-up (16.5% vs. 7%, P = 0.04). By multivariate analysis, PPM (HR = 2.4 [1.02–6], P = 0.04) independently predicted CHF whereas LVEF, Paravalvular leakage ≥1, age and male gender did not. By subgroup analysis, patients with MR ≥2 were more vulnerable to PPM as they experienced a prohibitive risk of CHF (HR = 51.4 [2.61–99], P = 0.006). PPM after TAVR with S3-THV is not a risk factor for midterm mortality but is an independent predictor of CHF, especially in the subset of patients with MR ≥2.