Incidence, Predictors, and Clinical Impact of Prosthesis–Patient Mismatch Following Transcatheter Aortic Valve Replacement in Asian Patients

Miyamoto, Masaki; Tada, Norio; Taguri, Masataka; Kato, Shigeaki; Enta, Yusuke; Otomo, Takanobu; Hara, Masaki; Watanabe, Yusuke; Naganuma, Toru; Araki, Motoharu; Yamanaka, Futoshi; Shirai, Shinichi; Ueno, Hiroshi; Mizutani, Kazuki; Tabata, Minoru; Higashimori, Akira; Takagi, Kensuke; Yamamoto, Masanori; Hayashida, Kentaro; Investigators, Ocean-Tavi

doi:10.1016/j.jcin.2018.01.273

Cited by 91 publications

(70 citation statements)

References 32 publications

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“…Black race was an independent predictor of PPM (52.9%) in our study, with significantly higher prevalence compared with other ethnicities . Our study findings contradict those of study using the Nationwide Inpatient Sample database that found no significant difference of TAVR outcomes between African American and Caucasian patients .…”

Section: Discussioncontrasting

confidence: 98%

“…Patients with older age often have lower BMI, which was associated with a lower risk of PPM. Patients less than 70 had the highest incidence of PPM and had an almost 4‐fold increased risk compared to age more than 90, similar to previous studies . Previous authors advised caution when selecting TAVR valves in patients of large body surface area (BSA) and small aortic annulus, where higher risk of PPM was expected.…”

Section: Discussionsupporting

confidence: 79%

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Predictors and outcomes of patient‐prosthesis mismatch after transcatheter aortic valve replacement

et al. 2019

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Background: Patient-prosthesis mismatch (PPM) has been shown to be associated with adverse outcomes after surgical aortic valve replacement. There is limited data on its risk and impact after transcatheter aortic valve replacement (TAVR), especially with the newer generation heart valves.Objectives: The objective of this study is to investigate the incidence, predictors, and clinical outcomes of PPM after TAVR.Methods: This is a retrospective study of 991 consecutive patients who underwent TAVR procedure at a tertiary referral center, between April 2012 and February 2019. Patients were stratified by the presence or absence of PPM, defined as an effective orifice area/body surface area ratio ≤0.85 cm 2 /m 2 . Multivariable logistic regression analysis was used to determine independent predictors of PPM. Kaplan-Meier survival estimates were used to determine overall 5-year survival.Results: PPM was encountered in 27.6% of patients. In multivariable analysis, age less than 70 years (P = .062), body mass index (BMI) more than 30 (P = .0057), history of atrial fibrillation (P = .0004), black race (P = .0078), and Sapien 3 sizes 20 and 23 mm (P < .0001)emerged as independent predictors of PPM. Sapien 3 valve size 20/23 mm was associated with higher risk of PPM compared to other valve types. Patients with PPM had comparable postoperative outcomes and overall 5-year survival. There was no significant difference in postoperative complications between patient groups. PPM was not associated with worse overall survival (56% for both PPM and no-PPM patients, log-rank P = .80).Conclusions: Younger age, atrial fibrillation, black race, higher BMI were predictors of PPM. Smaller sizes balloon-expandable valves had a higher risk of PPM. K E Y W O R D S aortic stenosis, cardiac surgery, patient-prosthesis mismatch, TAVR Abbreviations: TAVR, transcatheter aortic valve replacement; SAVR, surgical aortic valve replacement; PPM, patient-prosthesis mismatch; BMI, body mass index.

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Section: Discussioncontrasting

confidence: 98%

Section: Discussionsupporting

confidence: 79%

Predictors and outcomes of patient‐prosthesis mismatch after transcatheter aortic valve replacement

et al. 2019

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“…Finally, patients with no and moderate PPM exhibited greater frequency of ≥ moderate aortic regurgitation than severe PPM 31 . However, other studies suggested severe PPM has no impact on mortality, possible impact in the absence of paravalvular regurgitation, with possible less symptomatic improvement 25‐27,29,30,32,35,36 …”

Section: Ppm Outcomes After Savr/tavrmentioning

confidence: 97%

“…There have been multiple, and sometimes disparate, reports on the definitions, measurements, and prognostic value of PPM following SAVR and TAVR 25‐42 …”

Section: Prosthesis Patient Mismatchmentioning

confidence: 99%

Hemodynamic principles of prosthetic aortic valve evaluation in the transcatheter aortic valve replacement era

et al. 2020

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Evaluating the hemodynamic performance of aortic valve prostheses has relied primarily on echocardiography. This involves calculating the trans-prosthetic valve mean gradient (MG) and aortic valve area (AVA), and assessing for valvular and paravalvular regurgitation in a fashion similar to the native aortic valve. In conjunction with other echocardiographic and nonechocardiographic parameters, MG and AVA are used to distinguish between prosthesis stenosis, prosthesis patient mismatch, pressure recovery, increased flow, and measurement errors. This review will discuss the principles and limitations of echocardiographic evaluation of aortic valve prosthesis following surgical, and transcatheter aortic valve replacement and in comparison to invasive hemodynamics through illustrative clinical cases. K E Y W O R D S Bernoulli equation, continuity equation, echocardiography and catheterization discordance, pressure recovery, prosthesis patient mismatch, transcatheter aortic valve replacement | 739 ABBAS et Al.

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“…The same mechanism (less oversizing) has been suggested by a recent study that found that the incidence of PPM is significantly higher after TAVR with Sapien 3 as compared to Sapien XT and CoreValve bioprostheses. 23 Moreover, adding an external pericardial wrap to the Evolut R platform (Evolut Pro) was not associated with a lower EOA or increased gradients, 24 suggesting that a paravalvular sealing skirt per se does not compromise the bioprosthesis hemodynamics.…”

Section: The Incidence and Predictors Of Ppm After Tavrmentioning

confidence: 99%

Impact of prosthesis‐iteration evolution and sizing practice on the incidence of prosthesis–patient mismatch after transcatheter aortic valve replacement

Abdelghani

Allali

Kaur

et al. 2018

Cathet Cardio Intervent

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Objectives To investigate the impact of the introduction of the next generation self‐expanding (SE) and balloon‐expandable (BE) transcatheter heart valves (THVs) on the incidence of prosthesis–patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR). Background PPM is a risk factor for accelerated degeneration of bioprosthetic aortic valves. Data on PPM after TAVR are derived mainly from studies of older generation THVs. Methods PPM was assessed at 30 days post‐TAVR with the older generation (Medtronic CoreValve, n = 120 and Edwards Sapien XT, n = 121) and the next generation THVs (Medtronic Evolut R/Pro, n = 136 and Edwards Sapien 3, n = 363). Results The incidence of any and severe PPM was 15.1% and 0.0% for the older generation THVs, and 42.8% and 12.1% for the next generation THVs. The incidence of moderate and severe PPM was 23.3% and 3.5% in patients who received an Evolut R/Pro vs. 33.1% and 14.7% in those who received a Sapien 3 (P < 0.001). On multivariable analysis, TAVR with the Sapien 3 THV was not associated with PPM, while left ventricular ejection fraction (0.97 [0.95–0.99], P = 0.002), history of myocardial infarction (2.09 [1.00–4.34], P = 0.049), annulus maximum diameter (0.84 [0.77–0.92], P < 0.001), and THV oversizing (0.90 [0.87–0.94], P < 0.001) were independently associated with PPM. In Sapien 3, the risk of any and severe PPM was higher in those with no oversizing (odds ratio: 3.25 [1.23–8.53], P = 0.017 and 5.79[2.33–14.36], P < 0.001). Conclusions The incidence of PPM in contemporary TAVR is significant, especially with the next generation BE THV without adequate oversizing.

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Incidence, Predictors, and Clinical Impact of Prosthesis–Patient Mismatch Following Transcatheter Aortic Valve Replacement in Asian Patients

Abstract: The low prevalence of PPM and mortality at 1 year in patients with PPM after TAVR in this Japanese cohort implies that PPM is not a risk factor for mid-term mortality in Asian patients who have undergone TAVR.

Cited by 91 publications

References 32 publications

Predictors and outcomes of patient‐prosthesis mismatch after transcatheter aortic valve replacement

Predictors and outcomes of patient‐prosthesis mismatch after transcatheter aortic valve replacement

Hemodynamic principles of prosthetic aortic valve evaluation in the transcatheter aortic valve replacement era

Impact of prosthesis‐iteration evolution and sizing practice on the incidence of prosthesis–patient mismatch after transcatheter aortic valve replacement

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