Outcomes of Prosthesis-Patient Mismatch Following Supra-Annular Transcatheter Aortic Valve Replacement: From the STS/ACC TVT Registry.

Abstract

OBJECTIVES:

The 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]).

BACKGROUND:

Severe PPM has been associated with adverse outcomes following TAVR, yet the clinical outcome of severe PPM after supra-annular TAVR is largely unknown.

METHODS:

Supra-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.

RESULTS:

Severe 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).

CONCLUSIONS:

Severe 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).

• 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
• Journal: JACC. Cardiovascular interventions (JACC Cardiovasc Interv) Vol. 14 Issue 9 Pg. 964-976 (05 10 2021) ISSN: 1876-7605 [Electronic] United States
• PMID: 33958170 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Topics

• Aortic Valve (diagnostic imaging, surgery)
• Aortic Valve Stenosis (diagnostic imaging, surgery)
• Heart Valve Prosthesis
• Humans
• Prosthesis Design
• Registries
• Risk Factors
• Transcatheter Aortic Valve Replacement (adverse effects)
• Treatment Outcome