Prosthesis-patient mismatch (i.e. a difference between the size of the implanted prosthetic valve and the patient body size) in patients who undergo surgery is associated with worse outcomes. This may also apply to percutaneous prostheses, although that has not been well-studied yet. This work, presented at TCT 2018 and published simultaneously in JACC, analyzes this problem in 62,125 patients included in the TVT Registry between 2014 and 2017.
Based on the echocardiographic effective valve area indexed to body surface area, the mismatch was classified as severe (<0.65 cm²/m²), moderate (0.65 to 0.85 cm²/m²), or none (>0.85 cm²/m²).
Severe and moderate mismatch were present after transcatheter aortic valve replacement (TAVR) in 12% and 25% of patients, respectively. Predictors for these included small (<23-mm diameter) valve prosthesis, valve-in-valve procedure, larger body surface area, female sex, younger age, lower ejection fraction, atrial fibrillation, or severe mitral or tricuspid regurgitation.
Read also: TCT 2018 | COAPT: MitraClip in Patients with Secondary Mitral Regurgitation.
At 1 year, mortality was 17.2%, 15.6%, and 15.9% in patients with severe, moderate, and no mismatch, respectively (p = 0.02). Something similar was observed regarding readmissions due to heart failure. There was no association between mismatch and 1-year stroke or quality of life.
Original title: Prosthesis-Patient Mismatch in 62,125 Patients Following Transcatheter Aortic Valve Replacement: From the STS/ACC TVT Registry.
Presenter: Howard C. Herrmann.
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