Prosthesis-patient mismatch after transcatheter aortic valve replacement: prevalence and medium term prognostic impact

Pino, Maria del Carmen León del; Ortiz, Martín Ruiz; Ortega, Mónica Delgado; Fernández, José Sánchez; Quero, C Ferreiro; Jiménez, Enrique Durán; Romero, Miguel; Saint-Gerons, Jose Segura; Pineda, Soledad Ojeda; Álvarez‐Ossorio, Manuel Pan; Rubio, Dolores Mesa

doi:10.1007/s10554-018-01519-z

Cited by 17 publications

(18 citation statements)

References 38 publications

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“…TAVR has provided a reasonable option for patients who are at a higher surgical risk and there is a growing body of evidence regarding the use of TAVR for patients with SAA. Leon del Pino et al 57 analyzed a group of patients undergoing TAVR and found that 25% of their cohort developed PPM. Notably, predictors of PPM in this group included SAA and smaller prosthesis size 57 .…”

Section: Resultsmentioning

confidence: 99%

“…Leon del Pino et al 57 analyzed a group of patients undergoing TAVR and found that 25% of their cohort developed PPM. Notably, predictors of PPM in this group included SAA and smaller prosthesis size 57 . Another study assessed elderly patients with SAA and severe AS and found that TAVR provided favorable hemodynamic outcomes in this population 18 .…”

Section: Resultsmentioning

confidence: 99%

“…Notably, predictors of PPM in this group included SAA and smaller prosthesis size. 57 Another study assessed elderly patients with SAA and severe AS and found that TAVR provided favorable hemodynamic outcomes in this population. 18 The rate of severe PPM in both of these studies was approximately 6%.…”

Section: Transcatheter Avr (Tavr)mentioning

confidence: 99%

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Surgical aortic valve replacement in small aortic annulus

Vaidya

Cavanaugh

Sandhu

2021

Journal of Cardiac Surgery

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Background: Although aortic valve replacement (AVR) has been the standard of treatment for severe aortic stenosis, a small aortic annulus (SAA) poses significant challenges. Improvements in valve designs and evolution in surgical techniques have led to improved outcomes, however, the ideal prosthetic valve remains elusive.Methods: We performed a comprehensive literature review to discuss the surgical management of aortic stenosis, with a special focus on patients with SAA.Results: Stentless valves and root replacement techniques have been shown to overcome the hemodynamic challenges associated with conventional stented bioprostheses, but are technically challenging and require longer cross-clamp times. Sutureless and rapid deployment valves mitigate the long operative time while maintaining the hemodynamic advantages. The use of transcatheter AVR has emerged as another reasonable alternative and has shown promise among patients with SAA, however, long-term outcomes are awaited. Conclusion:There is no consensus regarding the type of valve prosthesis or replacement technique among patients with SAA. Consideration of patient comorbidities and valvular anatomy is paramount in planning the optimal strategy for AVR. Further long-term clinical trials are necessary to assess outcomes and achieve progress toward the development of the ideal prosthesis. K E Y W O R D S aorta and great vessels, clinical review, valve repair/replacement 1 | INTRODUCTION Valvular aortic stenosis (AS) is a disease characterized by leaflet thickening and calcification. Left untreated, it progresses from early sclerotic lesions to left ventricular outflow obstruction, resulting in reduced cardiac output, decreased exercise tolerance, heart failure, and death. 1 Valvular anatomy, hemodynamics, symptoms, as well as effects on left ventricular function, determine the severity of disease (Table 1). | METHODSA search was conducted on PubMed and results were reviewed for articles published up until April 30, 2020. Search terms included "aortic stenosis," "aortic valve replacement," "small aortic annulus," "aortic valve disease," and "cardiac surgery," or any combination thereof. All article types including original fulllength articles, meta-analyses, prior reviews, and case series were included.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Surgical aortic valve replacement in small aortic annulus

Vaidya

Cavanaugh

Sandhu

2021

Journal of Cardiac Surgery

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“…A total of 1,092 citations were identified, of which 116 studies were potentially relevant and retrieved as full-text. Seventeen publications [10-26] fulfilled our eligibility criteria. Interobserver reliability of study relevance was excellent (Kappa=0.85).…”

Section: Resultsmentioning

confidence: 99%

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

Cavalcanti¹,

Sarargiotto²,

Perazzo³

et al. 2019

Braz J Cardiovasc Surg

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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.

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“…Similar findings have been reported in previous studies. 25,26) Additionally, Poulin, et al showed that greater reverse LV remodeling using myocardial strain in patients without PPM compared with those with moderate or severe PPM. 21) Based on these findings, the small indexed effective orifice area and its residual high-pressure gradient may suppress improvements in 123I-MIBG parameters.…”

Section: Discussionmentioning

confidence: 99%