1. Long-term outcome of prosthesis-patient mismatch after transcatheter aortic valve replacement
- Author
-
Maria Letizia Bacchi Reggiani, Antonio Bruno, Mateusz Orzalkiewicz, Giulia Marchetti, Nazzareno Galiè, Nevio Taglieri, Francesco Saia, Miriam Compagnone, Tullio Palmerini, Cinzia Marrozzini, Gabriele Ghetti, Compagnone M., Marchetti G., Taglieri N., Ghetti G., Bruno A.G., Orzalkiewicz M., Marrozzini C., Bacchi Reggiani M.-L., Palmerini T., Galie N., and Saia F.
- Subjects
medicine.medical_specialty ,Aortic valve stenosi ,Degenerated aortic valve bioprosthesi ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Prosthesis Design ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Risk Factors ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Risk factor ,Stroke ,Bioprosthesis ,Heart Valve Prosthesis Implantation ,business.industry ,Incidence (epidemiology) ,Prosthesis-patient mismatch ,Aortic Valve Stenosis ,medicine.disease ,Confidence interval ,Treatment Outcome ,Aortic Valve ,Heart Valve Prosthesis ,Aortic valve stenosis ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Body mass index - Abstract
Background Incidence and long-term clinical consequences of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) are still unclear. Methods We enrolled 710 consecutive patients who underwent TAVR. PPM was defined as absent if the index orifice area (iEOA) was >0.85 cm2/m2, moderate if the iEOA was between 0.65 and 0.85 cm2/m2 or severe if the iEOA was Results Among the 566 patients fulfilling the study criteria, the distribution of PPM was as follows: 50.5% none (n = 286), 43% moderate PPM (n = 243) and 6.5% severe PPM (n = 37). At 5-year follow-up, patients with severe PPM had a significantly higher incidence of the combined endpoint of cardiovascular death, acute myocardial infarction and stroke (p = .025) compared with the other patients. After adjusting the results for possible confounders, severe PPM remained an independent predictor of long-term adverse outcome (HR: 2.46; 95% Confidence Interval: 1.10–5.53). The independent predictors of severe PPM were valve-in-valve procedure and body mass index. Balloon-expandable valves were not associated with higher rates of severe PPM in comparison with self-expandable valves (8% vs. 5%, respectively, p = .245). Conclusions In our study severe PPM emerged as a risk factor for long-term major adverse cardiac and cerebrovascular events.
- Published
- 2020