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Prosthesis–Patient Mismatch After TAVR in Asians
Study Questions:
What are the prevalence, risk factors, and mid-term mortality in Asian patients with prosthesis–patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR)?
Methods:
The investigators analyzed 1,558 patients enrolled in the OCEAN-TAVI (Optimized transCathEter vAlvular iNtervention) Japanese multicenter registry from October 2013 to July 2016 after excluding patients who died following TAVR before discharge. PPM was defined as moderate if ≥0.65 but ≤0.85 cm2/m2, or severe if <0.65 cm2/m2 at the indexed effective orifice area by post-procedural echocardiography. The primary study endpoints were all-cause and cardiovascular mortality at 1 year, and the secondary endpoint was rehospitalization due to congestive heart failure at 1 year. Cumulative survival rates were analyzed using the Kaplan-Meier method, and differences were assessed with the log-rank test.
Results:
Of the 1,546 patients, moderate and severe PPM were observed in 138 (8.9%) and 11 (0.7%) patients, respectively. These 149 patients were included in the PPM group. The median age and body surface area (BSA) were 85 years (interquartile range [IQR], 81-88 years) and 1.41 m2 (IQR, 1.30-1.53 m2), respectively. In the multivariate analysis, younger age, larger BSA, smaller aortic valve area (AVA), smaller annulus area, no balloon post-dilatation, and use of Edwards Sapien 3 (Edwards Lifesciences, Irvine, CA) were identified as independent predictors of PPM. The estimated cumulative all-cause mortality at 1 year using the Kaplan-Meier method was similar between the PPM and non-PPM groups (10.2% vs. 8.3%; log-rank; p = 0.41).
Conclusions:
The authors concluded that the low prevalence of PPM and mortality at 1 year in patients with PPM after TAVR in this Japanese cohort implies that PPM is not a risk factor for mid-term mortality in Asian patients who have undergone TAVR.
Perspective:
This study reports that the incidence of moderate and of severe PPM after TAVR in this study cohort was 8.9% and 0.7%, respectively. Furthermore, the cumulative all-cause and cardiovascular mortality at 1 year in the PPM group were similar to those in the non-PPM group. In this study, predictors of PPM were identified as younger age, larger BSA, no balloon post-dilatation, smaller AVA, use of Sapien 3, and smaller annulus area. Overall, these findings suggest that PPM is not a risk factor for mortality in Asian patients who have undergone TAVR in the intermediate-term, but longer-term 3- to 5-year follow-up of this cohort is needed.
Keywords: Body Surface Area, Cardiac Surgical Procedures, Dilatation, Echocardiography, Geriatrics, Heart Failure, Heart Valve Diseases, Heart Valve Prosthesis, Risk Factors, Secondary Prevention, Transcatheter Aortic Valve Replacement
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