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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.
Clinical Topics: Cardiac Surgery, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Valvular Heart Disease, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Imaging, Interventions and Structural Heart Disease, Echocardiography/Ultrasound
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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