Outcomes of Prosthesis-Patient Mismatch Following Supra-Annular Transcatheter Aortic Valve Replacement: From the STS/ACC TVT Registry |
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| Authors: | Gilbert H.L. Tang Aditya Sengupta Sophia L. Alexis Vinayak N. Bapat David H. Adams Samin K. Sharma Annapoorna S. Kini Susheel K. Kodali Basel Ramlawi Hemal Gada Amit N. Vora John K. Forrest Ryan K. Kaple Fang Liu Michael J. Reardon |
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| Affiliation: | 1. Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, New York, USA;2. Divisions of Cardiac Surgery and Cardiology, Columbia University Medical Center, New York, New York, USA;3. Department of Cardiac Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania, USA;4. Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle Heart and Vascular Institute, Wormleysburg, Pennsylvania, USA;5. Division of Cardiology, Yale University School of Medicine, New Haven, Connecticut, USA;6. Department of Biostatistics, Medtronic, Minneapolis, Minnesota, USA;7. Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Institute, Houston, Texas, USA |
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| Abstract: | ObjectivesThe aim of this study was to assess the outcomes of severe prosthesis-patient mismatch (PPM) in the TVT (Transcatheter Valve Therapy) Registry in patients undergoing supra-annular transcatheter aortic valve replacement (TAVR) for de novo stenosis or failed surgical bioprostheses (transcatheter aortic valve [TAV]–in–surgical aortic valve [SAV]).BackgroundSevere PPM has been associated with adverse outcomes following TAVR, yet the clinical outcome of severe PPM after supra-annular TAVR is largely unknown.MethodsSupra-annular TAVR was performed in patients enrolled in the TVT Registry with de novo stenosis (n = 42,174) or TAV-in-SAV (n = 5,446). Valve Academic Research Consortium-3 criteria were used to define severe PPM. The clinical impact of severe PPM on 1-year mortality and valve-related readmission was assessed using multivariate regression. A generalized linear mixed model was used to evaluate predictors of severe PPM.ResultsSevere PPM was found in 5.3% of patients undergoing de novo TAVR and 27.0% of patients undergoing TAV-in-SAV. The presence of severe PPM was not significantly associated with 1-year mortality or valve-related readmissions in both groups. Mean aortic gradients were higher in patients with severe PPM than in those without severe PPM at 1 month (9.7 ± 5.7 mm Hg vs. 7.3 ± 4.0 mm Hg; p < 0.001) and 1 year (10.2 ± 6.4 mm Hg vs. 8.0 ± 4.3 mm Hg; p < 0.001). Pre-procedural factors, including a <20-mm aortic annulus, were positive predictors of severe PPM in patients undergoing de novo TAVR (area under the curve = 0.795) and TAV-in-SAV (area under the curve = 0.764).ConclusionsSevere PPM after supra-annular TAVR was not associated with increased 1-year mortality or valve-related readmissions. Longer-term follow-up is needed to determine if higher residual gradients in patients with severe PPM predict long-term outcomes. (STS/ACC Transcatheter Valve Therapy Registry [TVT Registry]; NCT01737528) |
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