Journal article
Prosthesis-Patient Mismatch Following Transcatheter Aortic Valve Replacement With Supra-Annular and Intra-Annular Prostheses.
- Okuno T Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
- Khan F Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
- Asami M Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
- Praz F Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
- Heg D Clinical Trials Unit, University of Bern, Bern, Switzerland.
- Winkel MG Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
- Lanz J Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
- Huber A Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland.
- Gräni C Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
- Räber L Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
- Stortecky S Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
- Valgimigli M Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
- Windecker S Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
- Pilgrim T Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland. Electronic address: thomas.pilgrim@insel.ch.
- 2019-10-01
Published in:
- JACC. Cardiovascular interventions. - 2019
aortic stenosis
intra-annular valve
prosthesis-patient mismatch
supra-annular valve
transcatheter aortic valve replacement
Aged
Aged, 80 and over
Aortic Valve
Balloon Valvuloplasty
Female
Heart Valve Diseases
Heart Valve Prosthesis
Hemodynamics
Humans
Male
Prosthesis Design
Recovery of Function
Registries
Risk Assessment
Risk Factors
Switzerland
Time Factors
Transcatheter Aortic Valve Replacement
Treatment Outcome
English
OBJECTIVES
This study sought to compare the frequency of prosthesis-patient mismatch (PPM) with self-expandable valves (SEV) to balloon-expandable valves (BEV).
BACKGROUND
PPM has been associated with increased mortality after transcatheter aortic valve replacement. Data on the frequency of PPM as a function of supra-annular or intra-annular position of transcatheter heart valves are insufficient.
METHODS
A total of 757 patients treated with SEV (CoreValve, Evolut R) and BEV (SAPIEN THV/XT/3) were enrolled in the present analysis between August 2007 and June 2017. PPM was classified based on discharge prosthetic effective orifice area indexed to body surface area (BSA) as severe (<0.65 cm2/m2) or moderate (0.65 to 0.85 cm2/m2) in the general population, and as severe (<0.60 cm2/m2) or moderate (0.60 to 0.90 cm2/m2) in the obese population (body mass index ≥30 kg/m2).
RESULTS
Propensity score matching resulted in 224 matched pairs. At discharge, SEV were associated with a lower incidence of PPM compared with BEV (PPM, 33.5% vs. 46.9%; p = 0.004; severe PPM, 6.7% vs. 15.6%; p = 0.003). The lower frequency of severe PPM in SEV was observed even in patients with larger annulus. Although patients with BSA >1.83 m2 had a significantly lower incidence of PPM with SEV compared with BEV, there was no significant difference in patients with BSA ≤1.83 m2. We found no impact of PPM on cardiovascular mortality or New York Heart Association functional class at 1 year.
CONCLUSIONS
SEV were associated with a lower frequency of PPM compared with BEV irrespective of annulus area. The difference was mainly driven by larger patients with BSA >1.83 m2.
This study sought to compare the frequency of prosthesis-patient mismatch (PPM) with self-expandable valves (SEV) to balloon-expandable valves (BEV).
BACKGROUND
PPM has been associated with increased mortality after transcatheter aortic valve replacement. Data on the frequency of PPM as a function of supra-annular or intra-annular position of transcatheter heart valves are insufficient.
METHODS
A total of 757 patients treated with SEV (CoreValve, Evolut R) and BEV (SAPIEN THV/XT/3) were enrolled in the present analysis between August 2007 and June 2017. PPM was classified based on discharge prosthetic effective orifice area indexed to body surface area (BSA) as severe (<0.65 cm2/m2) or moderate (0.65 to 0.85 cm2/m2) in the general population, and as severe (<0.60 cm2/m2) or moderate (0.60 to 0.90 cm2/m2) in the obese population (body mass index ≥30 kg/m2).
RESULTS
Propensity score matching resulted in 224 matched pairs. At discharge, SEV were associated with a lower incidence of PPM compared with BEV (PPM, 33.5% vs. 46.9%; p = 0.004; severe PPM, 6.7% vs. 15.6%; p = 0.003). The lower frequency of severe PPM in SEV was observed even in patients with larger annulus. Although patients with BSA >1.83 m2 had a significantly lower incidence of PPM with SEV compared with BEV, there was no significant difference in patients with BSA ≤1.83 m2. We found no impact of PPM on cardiovascular mortality or New York Heart Association functional class at 1 year.
CONCLUSIONS
SEV were associated with a lower frequency of PPM compared with BEV irrespective of annulus area. The difference was mainly driven by larger patients with BSA >1.83 m2.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1016/j.jcin.2019.07.027
- PMID 31564593
- Persistent URL
- https://sonar.ch/global/documents/287903
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