Impact of Prosthesis-Patient Mismatch on 1-Year Outcomes after Transcatheter Aortic Valve Implantation: Meta-analysis of 71,106 Patients

Abstract

Objectives This study sought to evaluate the impact of prosthesis-patient mismatch (PPM) on the risk of early-term mortality after transcatheter aortic valve implantation (TAVI). Methods Databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], Cochrane Controlled Trials Register [CENTRAL/CCTR], ClinicalTrials.gov, Scientific Electronic Library Online [SciELO], Latin American and Caribbean Literature on Health Sciences [LILACS], and Google Scholar) were searched for studies published until February 2019. PPM after TAVI was defined as moderate if the indexed effective orifice area (iEOA) was between 0.85 cm 2 /m 2 and 0.65 cm 2 /m 2 and as severe if iEOA ≤ 0.65 cm 2 /m 2 . Results The search yielded 1,092 studies for inclusion. Of these, 18 articles were analyzed, and their data extracted. The total number of patients included who underwent TAVI was 71,106. The incidence of PPM after TAVI was 36.3% (25,846 with PPM and 45,260 without PPM). One-year mortality was not increased in patients with any PPM (odds ratio [OR] 1.021, 95% confidence interval [CI] 0.979-1.065, P =0.338) neither in those with moderate PPM (OR 0.980, 95% CI 0.933-1.029, P =0.423). Severe PPM was separately associated with high risk (OR 1.109, 95% CI 1.041-1.181, P =0.001). Conclusion The presence of severe PPM after TAVI increased early-term mortality. Although moderate PPM seemed harmless, the findings of this study cannot not rule out the possibility of it being detrimental, since there are other registries that did not address this issue yet.

Lifetime management of aortic valve disease: Aligning surgical and transcatheter armamentarium to set the tone for the present and the future

“…Experimental work showed that the origin of SVD of BHV is multifactorial 1 . Disturbance of hemodynamic flow patterns may have an influence on the structural integrity of BHVs over time and prosthesis–patient mismatch (PPM) seems to play a major role in SVD and mortality after SAVR/TAVR 2,3 . PPM was defined as a discrepancy between the EOA of the implanted BHV and the EOA required by the patient's own body size as measured by the body surface area (BSA) 2 .…”

“…Despite growing evidence to the contrary, 3,11 there seems to be currently a widespread belief that PPM might not affect the outcomes of TAVR (as if it posed a problem only to SAVR outcomes). Compagnone et al 11 published recently an incidence of 6.5% for severe PPM and 43% for moderate PPM among patients who underwent TAVR.…”

Clinical and Technical Challenges of Prosthesis–Patient Mismatch After Transcatheter Aortic Valve Implantation

“…Despite the above evidence in patients undergoing SAVR, the clinical impact of PPM in patients undergoing TAVI is not entirely clear to date. On one hand, its impact on prosthetic hemodynamic function and on clinical outcomes was progressively more recognized even among patients treated percutaneously (70,79,101,102): PPM was associated with less improvement in functional class, with reduced regression of ventricular mass and diastolic dysfunction, and with increased mortality, especially when severe (67,(103)(104)(105). This is concordant with data from the STS/ACC TVT registry, which showed a significant difference at 1 year in terms of mortality in patients with severe, moderate and non-PPM (17.2, 15.6, and 15.9%, respectively, p = 0.02), as well as in terms of re-hospitalization for heart failure (14.7, 12.8, and 11.9%, respectively, p < 0.0001) (72).…”

Bioprosthetic valve fracture for valve‐in‐valve transcatheter aortic valve implantation in patients with structural valve degeneration: Systematic review with meta‐analysis

“…Consequently, some patients can be left with a severe prosthesis-patient mismatch (PPM), 1 which can negatively impact the outcomes. 2 In this scenario, bioprosthetic valve fracture (BVF) emerged as a useful adjunct to ViV-TAVI, in which the surgical ring of a BSV is fractured by means of high-pressure balloon inflation, whereby interventional cardiologists and cardiac surgeons can optimize the expansion of the THV and improve the prosthetic effective orifice area (EOA), thereby avoiding PPM. [3][4][5][6] We conducted the present systematic review and meta-analysis to determine the outcomes of BVF in ViV-TAVI for patients with SVD of BSV.…”

“…1 Furthermore, other meta-analyses showed that severe PPM is associated with a higher risk of death already in the first year after TAVI. 2 On the about this issue at all. On the other hand, if we were dealing with younger patients, for example, those in their 60s or 50s, the impact of severe PPM would be much more concerning, and redo SAVR would be highly likely the best approach in these cases.…”