Racial Differences in Prosthesis-Patient Mismatch After TAVR

Dec 21, 2021
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Authors:
Park H, Ahn JM, Kang DY, et al.
Citation:
Racial Differences in the Incidence and Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2021;14:2670-2681.
Summary By:
Bina Ahmed, MD, FACC

Quick Takes

  • Incidence of PPM after TAVR is lower in Asian patients compared to non-Asian patients.
  • Presence of PPM after TAVR was not associated with worst 1-year clinical outcomes regardless of race.
  • Further study from larger data sets with longer follow-up will help answer important questions regarding TAVR among people of different races.

Study Questions:

What is the incidence and prognostic significance of patient-prosthesis mismatch (PPM) after transcatheter aortic valve replacement (TAVR) according to racial groups?

Methods:

The TP-TAVR (Transpacific TAVR Registry) was an international multicenter cohort study of patients with severe aortic stenosis (AS) who have undergone TAVR in the United States and South Korea from January 2015–November 2019. PPM was defined as moderate (0.65–0.85 cm2/m2) or severe (<0.65 cm2/m2) at the indexed effective orifice area. The primary outcome was a composite of death, stroke, or rehospitalization at 1 year.

Results:

Among 1,101 eligible patients (533 Asian and 569 non-Asian), the incidence of PPM was significantly lower in the Asian population (33.6%; moderate = 26.5%, severe = 7.1%) than in the non-Asian population (54.5%; moderate = 29.8%, severe = 24.7%). The 1-year rate of the primary outcome was similar between the PPM and non-PPM groups (27.5% vs. 28.1%; p = 0.69); this pattern was consistent among Asian (25.4% vs. 25.2%; p = 0.31) and non-Asian (28.7% vs. 32.1%; p = 0.97). After multivariable adjustment, the risk for the primary outcome did not significantly differ between the PPM and non-PPM groups in the overall population (hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.74–1.21), in Asian patients (HR, 1.07; 95% CI, 0.74–1.55), and in non-Asian patients (HR, 0.86; 95% CI, 0.63–1.19).

Conclusions:

In this study of patients with severe AS who have undergone TAVR, the incidence of PPM was significantly lower in Asian patients compared to non-Asian patients. The 1-year risk for the primary composite outcome was similar between the PPM and non-PPM groups regardless of racial groups.

Perspective:

Findings from this observational cohort show that the incidence of PPM after TAVR is lower in Asian patients compared to non-Asian patients and that PPM itself is not predictive of worst clinical outcomes regardless of race. Although prior data comparing race-based differences in PPM have been sparse, observational findings from this study counter the common perception that smaller patients are more likely to have PPM and that PPM has a poor prognosis. Further study from larger data sets with longer follow-up will help answer important questions regarding TAVR among people of different races.

Clinical Topics: Cardiac Surgery, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and VHD, Interventions and Structural Heart Disease

Keywords: Aortic Valve Stenosis, Asian Continental Ancestry Group, Geriatrics, Heart Valve Diseases, Heart Valve Prosthesis, Outcome Assessment, Health Care, Race Factors, Risk, Stroke, Transcatheter Aortic Valve Replacement


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