TY - JOUR
T1 - Impact of Measured and Predicted Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement
AU - the IMPPACT TAVR Investigators
AU - Guthoff, Henning
AU - Abdel-Wahab, Mohamed
AU - Kim, Won Keun
AU - Witberg, Guy
AU - Wienemann, Hendrik
AU - Thurow, Maria
AU - Shamekhi, Jasmin
AU - Eckel, Clemens
AU - von der Heide, Ina
AU - Veulemans, Verena
AU - Landt, Martin
AU - Barbanti, Marco
AU - Finkelstein, Ariel
AU - Schewel, Jury
AU - Van Mieghem, Nicolas
AU - Adrichem, Rik
AU - Toggweiler, Stefan
AU - Rheude, Tobias
AU - Nombela-Franco, Luis
AU - Amat-Santos, Ignacio J.
AU - Ruile, Philipp
AU - Estévez-Loureiro, Rodrigo
AU - Bunc, Matjaz
AU - Branca, Luca
AU - De Backer, Ole
AU - Tarantini, Giuseppe
AU - Mylotte, Darren
AU - Arzamendi, Dabit
AU - Pauly, Markus
AU - Bleiziffer, Sabine
AU - Renker, Matthias
AU - Al-Kassou, Baravan
AU - Möllmann, Helge
AU - Ludwig, Sebastian
AU - Zeus, Tobias
AU - Tamburino, Corrado
AU - Schmidt, Tobias
AU - Rück, Andreas
AU - von Stein, Philipp
AU - Thiele, Holger
AU - Abdelhafez, Ahmed
AU - Adam, Matti
AU - Baldus, Stephan
AU - Rudolph, Tanja
AU - Mauri, Victor
AU - Blumstein, Johannes
AU - Frerker, Christian
AU - Hecht, Salome
AU - Hein, Manuel
AU - Joner, Michael
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2024/11/25
Y1 - 2024/11/25
N2 - Background: Prosthesis-patient mismatch after transcatheter aortic valve replacement (TAVR) can be measured echocardiographically (measured prosthesis-patient mismatch [PPMm]) or predicted (predicted prosthesis-patient mismatch [PPMp]) using published effective orifice area (EOA) reference values. However, the clinical implications of PPM post-TAVR remain unclear. Objectives: This study aimed to elucidate the prevalence of PPMm and PPMp post-TAVR and their impact on mortality in a large international cohort. Methods: The IMPPACT TAVR (Impact of Measured or Predicted Prosthesis-pAtient mismatCh after TAVR) registry included 38,808 TAVR patients from 26 international centers. Valve Academic Research Consortium 3 criteria were used to define prosthesis-patient mismatch severity. EOA was determined echocardiographically (PPMm) or predicted (PPMp) based on core lab–derived EOA reference values. The primary endpoint was 2-year all-cause mortality. Results: The prevalence of PPMp (moderate: 6.8%, severe: 0.6%) was significantly lower than that of PPMm (moderate: 20.7%, severe: 4.3%; P < 0.001) with negligible correlation between the 2 methods (Kendall's tau c correlation coefficient: 0.063; P < 0.001). In unadjusted analyses, severe PPMm adversely influenced 2-year survival (HR: 1.22; 95% CI: 1.02-1.45; P = 0.027), whereas severe PPMp was not associated with outcomes (HR: 0.81; 95% CI: 0.55-1.19; P = 0.291). After adjusting for confounders, neither PPMm nor PPMp had a significant effect on 2-year all-cause mortality. Conclusions: PPMm and PPMp were associated with different patient characteristics, with PPMm tending toward worse (especially low flow) and PPMp toward better (especially women) survival. After adjusting for confounders, neither PPMm nor PPMp significantly affected 2-year all-cause mortality. Hence, valve selection should not solely be based on hemodynamics but rather on a holistic approach, including patient and procedural specifics.
AB - Background: Prosthesis-patient mismatch after transcatheter aortic valve replacement (TAVR) can be measured echocardiographically (measured prosthesis-patient mismatch [PPMm]) or predicted (predicted prosthesis-patient mismatch [PPMp]) using published effective orifice area (EOA) reference values. However, the clinical implications of PPM post-TAVR remain unclear. Objectives: This study aimed to elucidate the prevalence of PPMm and PPMp post-TAVR and their impact on mortality in a large international cohort. Methods: The IMPPACT TAVR (Impact of Measured or Predicted Prosthesis-pAtient mismatCh after TAVR) registry included 38,808 TAVR patients from 26 international centers. Valve Academic Research Consortium 3 criteria were used to define prosthesis-patient mismatch severity. EOA was determined echocardiographically (PPMm) or predicted (PPMp) based on core lab–derived EOA reference values. The primary endpoint was 2-year all-cause mortality. Results: The prevalence of PPMp (moderate: 6.8%, severe: 0.6%) was significantly lower than that of PPMm (moderate: 20.7%, severe: 4.3%; P < 0.001) with negligible correlation between the 2 methods (Kendall's tau c correlation coefficient: 0.063; P < 0.001). In unadjusted analyses, severe PPMm adversely influenced 2-year survival (HR: 1.22; 95% CI: 1.02-1.45; P = 0.027), whereas severe PPMp was not associated with outcomes (HR: 0.81; 95% CI: 0.55-1.19; P = 0.291). After adjusting for confounders, neither PPMm nor PPMp had a significant effect on 2-year all-cause mortality. Conclusions: PPMm and PPMp were associated with different patient characteristics, with PPMm tending toward worse (especially low flow) and PPMp toward better (especially women) survival. After adjusting for confounders, neither PPMm nor PPMp significantly affected 2-year all-cause mortality. Hence, valve selection should not solely be based on hemodynamics but rather on a holistic approach, including patient and procedural specifics.
KW - effective orifice area
KW - predictors of mortality
KW - prevalence
KW - prosthesis-patient mismatch
KW - transcatheter aortic valve replacement
UR - https://www.scopus.com/pages/publications/85209259316
U2 - 10.1016/j.jcin.2024.08.041
DO - 10.1016/j.jcin.2024.08.041
M3 - Article
AN - SCOPUS:85209259316
SN - 1936-8798
VL - 17
SP - 2626
EP - 2635
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 22
ER -