Prosthesis-patient mismatch after transcatheter implantation of contemporary balloon-expandable and self-expandable valves in small aortic annuli.
Catheter Cardiovasc Interv
; 102(5): 931-943, 2023 11.
Article
em En
| MEDLINE
| ID: mdl-37668097
ABSTRACT
BACKGROUND:
Evidence of clinical impact of PPM after TAVI is conflicting and might vary according to the type of valve implanted.AIMS:
To assess the clinical impact of prosthesis-patient mismatch (PPM) after transcatheter aortic valve implantation (TAVI) with balloon-expandable (BEV) and self-expandable valves (SEV) in patients with small annuli.METHODS:
TAVI-SMALL 2 enrolled 628 patients in an international retrospective registry, which included patients with severe aortic stenosis and small annuli (annular perimeter <72 mm or area <400 mm2 ) treated with transfemoral TAVI at 16 high-volume centers between 2011 and 2020. Analyses were performed comparing patients with less than moderate (n = 452), moderate (n = 138), and severe PPM (n = 38). Primary endpoint was incidence of all-cause mortality. Predictors of all-cause mortality and PPM were investigated.RESULTS:
At a median follow-up of 380 days (interquartile range 210-709 days), patients with severe PPM, but not moderate PPM, had an increased risk of all-cause mortality when compared with less than moderate PPM (log-rank p = 0.046). Severe PPM predicted all-cause mortality in patients with BEV (hazard ratio [HR] 5.20, 95% confidence interval [CI] 1.27-21.2) and intra-annular valves (IAVs, HR 4.23, 95% CI 1.28-14.02), and it did so with borderline significance in the overall population (HR 2.89, 95% CI 0.95-8.79). Supra-annular valve (SAV) implantation was the only predictor of severe PPM (odds ratio 0.33, 95% CI 0.13-0.83).CONCLUSIONS:
Patients with small aortic annuli and severe PPM after TAVI have an increased risk of all-cause mortality at early term follow-up, especially after IAV or BEV implantation. TAVI with SAV protected from severe PPM.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Estenose da Valva Aórtica
/
Próteses Valvulares Cardíacas
/
Substituição da Valva Aórtica Transcateter
Tipo de estudo:
Prognostic_studies
Limite:
Humans
Idioma:
En
Revista:
Catheter Cardiovasc Interv
Assunto da revista:
CARDIOLOGIA
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Estados Unidos