Prosthesis-patient mismatch following transcatheter aortic valve replacement for degenerated transcatheter aortic valves

A severe prosthesis-patient mismatch (PPM) is associated with adverse outcomes following transcatheter aortic valve replacement (TAVR) for de novo aortic stenosis or a failed surgical bioprosthesis. The impact of severe PPM in patients undergoing TAV-in-TAVR is unknown. We sought to investigate the...

Full description

Bibliographic Details
Authors: Testa, Luca, Casenghi, Matteo, Criscione, Enrico|||0000-0002-1550-8531, Van Mieghem, Nicolas M., Tchétché, Didier, Asgar, Anita W., De Backer, Ole|||0000-0002-9674-0278, Latib, Azeem, Reimers, Bernhard, Stefanini, Giulio, Trani, Carlo, Giannini, Francesco, Bartorelli, Antonio, Wojakowski, Wojtek|||0000-0002-3681-5207, Dabrowski, Maciej, Jagielak, Dariusz, Banning, Adrian P., Kharbanda, Rajesh, Moreno, Raul, Schofer, Joachim, Brinkmann, Christina, van Royen, Niels|||0000-0001-6136-8640, Pinto, Duane, Serra, Antoni, Segev, Amit, Giordano, Arturo, Brambilla, Nedy, Agnifili, Mauro, Rubbio, Antonio Popolo, Squillace, Mattia, Oreglia, Jacopo, Tanja, Rudolph, McCabe, James M., Abizaid, Alexander, Voskuil, Michiel, Teles, Rui, Zoccai, Giuseppe Biondi, Sondergaard, Lars, Bedogni, Francesco
Format: article
Publication Date:2022
Country:España
Institution:Universitat Autònoma de Barcelona
Repository:Dipòsit Digital de Documents de la UAB
Language:English
OAI Identifier:oai:ddd.uab.cat:290583
Online Access:https://ddd.uab.cat/record/290583
https://dx.doi.org/urn:doi:10.3389/fcvm.2022.931207
Access Level:Open access
Keyword:TAVR
TAVR in TAVR
Failed TAVR
Mortality
Prosthesis-patient mismatch
Description
Summary:A severe prosthesis-patient mismatch (PPM) is associated with adverse outcomes following transcatheter aortic valve replacement (TAVR) for de novo aortic stenosis or a failed surgical bioprosthesis. The impact of severe PPM in patients undergoing TAV-in-TAVR is unknown. We sought to investigate the incidence and 1-year outcomes of different grades of PPM in patients undergoing TAV-in-TAVR. The TRANSIT-PPM is an international registry, including cases of degenerated TAVR treated with a second TAVR. PPM severity, as well as in-hospital, 30-day, and 1-year outcomes were defined according to the Valve Academic Research Consortium-3 (VARC-3) criteria. Among 28 centers, 155 patients were included. Severe PPM was found in 6.5% of patients, whereas moderate PPM was found in 14.2% of patients. The rate of severe PPM was higher in patients who underwent TAV-in-TAVR with a second supra-annular self-expanding (S-SE) TAVR (10%, p = 0.04). Specifically, the rate of severe PPM was significantly higher among cases of a SE TAVR implanted into a balloon-expandable (BE) device (19%, p = 0.003). At 1-year follow-up, the rate of all-cause mortality, and the rate of patients in the New York Heart Association (NYHA) class III/IV were significantly higher in the cohort of patients with severe PPM (p = 0.016 and p = 0.0001, respectively). Almost all the patients with a severe PPM after the first TAVR had a failed < 23 mm BE transcatheter heart valve (THV): the treatment with an S-SE resolved the severe PPM in the majority of the cases. After TAV-in-TAVR, in a fifth of the cases, a moderate or severe PPM occurred. A severe PPM is associated with an increased 1-year all-cause mortality.

Similar Items