CT-Defined Prosthesis–Patient Mismatch Downgrades Frequency and Severity, and Demonstrates No Association With Adverse Outcomes After Transcatheter Aortic Valve Replacement.

Objectives This study sought to determine if indexed effective orifice area (EOAi), using left ventricular outflow tract measured from computed tomography (EOAi CT ), reclassified prosthesis–patient mismatch (PPM) compared with conventional echocardiogram-defined measurements (EOAi TTE ). Background PPM does not predict mortality following transcatheter aortic valve replacement (TAVR). However, it is unknown if the EOAi CT of the left ventricular outflow tract improves risk stratification. Methods A total of 765 TAVR patients from the PARTNER II (Placement of Aortic Transcatheter Valves II) trial S3i cohort were evaluated. EOAi was calculated using the continuity equation, and the left ventricular outflow tract area was derived from baseline computed tomography. Traditional echocardiographic categories defined PPM: absent (>0.85 cm 2 /m 2 ), moderate (≥0.65 and ≤0.85 cm 2 /m 2 ), or severe (≤0.65 cm 2 /m 2 ). Correlation of EOAi CT and EOAi TTE to 1-year outcomes was performed. Results The incidence of PPM was 24% with EOA CT compared with 45% with EOAi TTE . Only 6% of PPM was graded severe by EOAi CT compared with 9% by EOAi TTE . EOAi TTE , but not EOAi CT , defined PPM showed association with reduced left ventricular mass regression (p = 0.03 vs. p = 0.52). There was no association between PPM and death or rehospitalization at 1 year with either modality. EOA CT was associated with minor stroke at 1 year (log-rank p = 0.04), and EOAi TTE with stroke/transient ischemic attack (log-rank p = 0.030). Furthermore, when subjects with mild or greater paravalvular regurgitation were excluded, the presence of PPM did not show association with any outcome. Conclusions EOAi CT downgrades frequency and severity of PPM in patients after TAVR, and was not associated with mortality 1 year after TAVR. EOAi TTE , but not EOAi CT , was associated with less left ventricular mass regression. [ABSTRACT FROM AUTHOR]