Mid-term impact of prosthesis-patient mismatch after transcatheter aortic valve implantation using a self-expanding or balloon-expandable transcatheter heart valve
Y Taniguchi, T Rheude, W K Kim, H Moellmann, A Linke, M Hilker, H Thiele, S Kerber, C Thilo, S Toggweiler, B Prendergast, O Husser, T Walther, S Windecker, M JonerAbstract
Background
The clinical relevance of prosthesis-patient mismatch (PPM) after transcatheter aortic valve implantation (TAVI) remains controversial. The aim of this study was to compare the frequency of PPM after TAVI using a self-expanding or a balloon-expandable transcatheter heart valve and to investigate the impact of PPM on clinical outcomes and health-related quality of life measures throughout three years.
Methods
Patients treated in the SCOPE I trial were stratified according to PPM, which was determined by the indexed effective orifice area (EOAi). All patients were stratified according to the EOAi: moderate PPM was defined as 0.66-0.85 cm2/m2 and severe PPM as ≤0.65 cm2/m2. Outcomes of interest included a composite endpoint integrating both vital status and patient-reported, disease-specific health status, as well as clinical endpoints defined according to VARC-3 criteria.
Results
A total of 701 patients were included. The frequency of any PPM was 41.9% (moderate 29.7% [208/701]; severe 12.3% [86/701]). Any PPM was more frequent with balloon-expandable prosthesis compared with self-expandable prosthesis (53.5% versus 29.9%, p <0.01). Patients with any PPM had less improvement in patient-reported health status after TAVI throughout three years compared to patients with no PPM (improvement of Kansas City Cardiomyopathy Questionnaire 12 Overall Summary score: +14.6 [3.1-32.3] vs. +21.4 [8.3-38.0], p=0.04). The rate of VARC-3 unfavorable outcome was comparable in patients with any and no PPM (16.5% vs. 18.4%, p=0.53). All-cause mortality at three years was not significantly increased in patients with any PPM (24.8% vs. 21.1%, Hazard Ratio 1.14, p=0.13).
Conclusions
PPM was frequently observed, especially in TAVI patients treated with balloon expandable valves. Patients with any PPM after TAVI had less improvement in patient-reported health status, without impact on all-cause mortality rates during extended follow-up.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.