Incidence, Predictors and Outcome of Prosthesis-Patient Mismatch after Transcatheter Aortic Valve Replacement: a Systematic Review and Meta-analysis

Abstract

The aim of this study was to investigate the incidence, predictors and outcome of prosthesis-patient mismatch (PPM) following transcatheter aortic valve replacement (TAVR). A total of 30 articles incorporating 4,691 patients were identified. The pooled incidences of overall, moderate and severe PPM following TAVR were 33.0%, 25.0% and 11.0% respectively. Medtronic CoreValve (MCV) had lower incidence of overall (32% vs: 40%, P < 0.0001) and moderate (23% vs 32%, P < 0.0001) than Edwards Sapien (ESV). PPM was associated with a younger age, smaller annulus diameter and lower left ventricular ejection fraction in comparison with those patients without PPM. Post-dilation (OR, 0.51, 95% CI, 0.38 to 0.68, p < 0.001) during TAVR would decrease the incidence of PPM. Although PPM was common after TAVR, no significant differences were observed both in short- and mid-term all-cause mortality (30 day: OR: 1.1, 95% CI, 0.70 to 1.73 and 2 year: OR: 1.01, 95% CI, 0.74 to 1.38) between patients with PPM and those without PPM. In conclusion, despite being common after TAVR, the incidence of PPM was lower than that of surgical aortic valve replacement (SAVR) and decreased with the experience accumulating, and PPM was not seen to impact on short- and mid-term survival, regardless of its magnitude.

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

“…In line with previous studies, we found that a lower EF and a history of myocardial infarction are associated with a higher incidence of PPM. A dysfunctioning LV may eject a smaller stroke volume than required to adequately open the aortic valve leaflets during ventricular ejection and, accordingly, contribute to EOA reduction.…”

Valve in valve transcatheter aortic valve implantation (ViV‐TAVI) versus redo—Surgical aortic valve replacement (redo‐SAVR): A systematic review and meta‐analysis

“…This could also be explained by inappropriate valve sizing and mal‐position which was associated with TAVI procedure during the early induction years. This trend might be reversing with increasing operator experience, aggressive post dilation and improved hemodynamic performance of the newer generation prostheses . However, the timing of assessment of paravalvular leak differed across studies although studies commonly used echocardiography to diagnose it.…”

“…This trend might be reversing with increasing operator experience, aggressive post dilation and improved hemodynamic performance of the newer generation prostheses. [33][34][35] However, the timing of assessment of paravalvular leak differed across studies although studies commonly used echocardiography to diagnose it.…”

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

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