Prosthesis–Patient Mismatch in Patients Undergoing Transcatheter Aortic Valve Replacement

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

“…This in line with the concept and premise of PPM described by Rahimtoola and others 24 . However, in the TAVR‐era, the only measure of severe PPM was the presence of the iEOA Echo < 0.65 cm 2 /m 2 regardless of an elevated AV velocity 31 . Dobutamine stress echocardiography or predicted iEOA Echo , have been suggested to differentiate true vs pseudo severe PPM in the presence of a low SVI 51 …”

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

A match not made in heaven—TAVR prosthesis‐patient mismatch with contemporary valves

“…Concern that PPM may be an underappreciated issue in transcatheter aortic valve replacement (TAVR) has now appeared on center stage, most recently drawing on data in the Transcatheter Valve Therapies Registry . The results, that moderate PPM was present in 25% and severe PPM in 12% are similar to the findings in the current study by Abdelghani et al The authors conclude that the extent of oversizing has an inverse relationship with subsequent PPM, an observation to be expected with the “larger is better” concept implied by the use of the effective orifice area (EOA) to BSA ratio to define the presence of PPM.…”

Current Key Issues in Transcatheter Aortic Valve Replacement Undergoing a Paradigm Shift

“…An analysis of the STS/ACC registry reported that severe and moderate PPM following TAVR were 12% and 25%, respectively. 23 However, landmark studies showed that a lower incidence of PPM incidence after TAVR than after SAVR, even when performed with a sutureless device. 24, 25 Because PPM incidence is associated with the size of both the aortic annulus and bioprosthesis, there has been a concern regarding PPM in patients with a small aortic annulus, especially in the Asian population.…”