Prosthesis-patient mismatch (PPM) was initially proposed by Rahimtoola and reintroduced by Pirabot.
PPM is the indexed effective orifice area in relation to body surface area, cutoff value being 0.85 cm2/m2, and <0.70 cm2/m2for obese patients. PPM is considered moderate if indexed effective orifice area is 0.65-0.85 cm2/m2 and severe when <0.65 cm2/m2
Research studies on surgical prosthesis have associated PPM with higher mortality at short, mid and long term.
There are few studies on post TAVR PPM. Unlike surgical prosthesis, its impact remains to be shown.
The current study is a meta-analysis of 23 studies with a total 81969 patients. 19612 presented some degree of PPM (23.9%).
Mortality was higher in patients presenting moderate/severe PPM (HR: 1.09 [95% CI: 1.04-1.14]; P < 0.001).
Within the first 30 months, mortality was higher in patients with moderate to severe PPM (HR: 1.1 [95% CI: 1.05-1.16]; P < 0.001). After 30 days, even though mortality was slightly higher, it did not reach statistical significance (HR 0.83 [95% CI: 0.68-1.01]; P = 0.064).
Read also: AQCA Study: Pre-PCI Virtual QFR for Planning PCI vs. Conventional Angiography.
Additionally, PPM moderate and severe were looked at separately, resulting in higher mortality the with more severe PPM, vs. patients with no PPM (HR: 1.25 [95% CI: 1.16-1.36]; P < 0.001). However, this was not the case when looking at moderate PPM (HR: 1.03 [95% CI: 0.96-1.10]; P = 0.398).
Conclusion
Severe PPM was associated to higher mortality at TAVR followup (unlike moderate PPM). These outcomes call for strategies to prevent severe PPM.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Original Title: Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement Meta-Analysis of Kaplan-Meier–Derived Individual Patient Data.
Reference: Michel Pompeu Sá, et al. J Am Coll Cardiol Img 2023;16:298–310.
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