Prosthesis‐Patient Mismatch in All‐Comer Patients Undergoing Newer‐Generation Self‐Expanding Transcatheter Aortic Valve Replacement
Xander Jacquemyn, Takuya Ogami, Irsa Hasan, Dustin Kliner, Derek Serna‐Gallegos, Catalin Toma, Amber Makani, David West, Ibrahim SultanABSTRACT
Background
Prosthesis‐patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) may affect outcomes, but its incidence and impact with contemporary self‐expanding valves remain unclear.
Aims
Evaluate the frequency, predictors, and long‐term outcomes of PPM in a real‐world TAVR population.
Methods
We analyzed patients ≥ 18 years undergoing TAVR with current‐generation self‐expanding valves (Evolut FX/FX+, PRO/PRO+, Navitor, Navitor Vision) from a prospectively maintained institutional database (2017–2025). Predicted PPM was defined according to VARC‐3 criteria, with all‐cause mortality and heart failure hospitalization as the primary outcomes.
Results
Among 2989 patients (median age 80 [75−85], 50.8% female) receiving Evolut (83.3%) or Navitor (16.7%) valves, PPM occurred in 5.0% (moderate 3.7%, severe 1.3%) and declined from 6.5% in 2017 to 2.7% in 2025 ( p = 0.002). Independent predictors of PPM included female sex (OR 2.04, 95% CI 1.06−3.99, p = 0.035) and valve‐in‐valve procedures (OR 9.60, 95% CI 3.82−25.64, p < 0.001), whereas use of the Navitor valve was associated with markedly lower odds (OR 0.07, 95% CI 0.00−0.32, p = 0.009). Patients with PPM demonstrated significantly higher post‐procedural transvalvular gradients and reduced aortic valve areas (both p < 0.001). PPM was not associated with adverse long‐term clinical outcomes, with no significant differences in 5‐year all‐cause mortality (HR 0.84, 95% CI 0.45−1.57, p = 0.592) or heart failure hospitalization (HR 1.22, 95% CI 0.84−1.77, p = 0.295).
Conclusion
In this contemporary TAVR cohort, PPM was infrequent, and its incidence declined over time. Female sex and valve‐in‐valve procedures independently predicted PPM. Despite adverse hemodynamic profiles, PPM was not associated with early or long‐term adverse clinical outcomes.