Gilbert HL 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
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]).
Severe PPM has been associated with adverse outcomes following TAVR, yet the clinical outcome of severe PPM after supra-annular TAVR is largely unknown.
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.
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).
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)
- David H. Adams, MD, Dimosthenis Pandis, MD, Shaf Keshavjee, MD
Propensity-Matched Comparison of the Ross Procedure and Prosthetic Aortic Valve Replacement in AdultsIsmail El-Hamamsy, MD, PhD, Nana Toyoda, MD, PhD, Shinobu Itagaki, MD, MSc, Paul Stelzer, MD, Robin Varghese, MD, Elbert E. Williams, MD, Natalia Egorova, PhD, David H. Adams, MD
- Amine Mazine, Nitish K Dhingra, Michael W A Chu, Ismail El-Hamamsy, Mark D Peterson
- Dimosthenis Pandis, MD, MSc, Anelechi C. Anyanwu, MD, FRCS, David H. Adams, MD, FACC