Valvular & structural heart disease
Echocardiographic and clinical features of patients developing prosthesis‐patient mismatch after transcatheter aortic valve replacement: Insights from the Recovery-TAVR registry
Authors' conclusion
PPM was observed in 18% of patients undergoing TAVR. Echocardiographic evaluations demonstrated a PPM-related pattern of early ventricular maladaptive alterations, possibly precursor to a reduction in cardiac function, associated with a significant deterioration in NYHA class at 1 year.
Study context
- Population
- Patients at intermediate and low surgical risk undergoing transcatheter aortic valve replacement (TAVR), 2017–2021 (RECOVERY-TAVR registry)
- Participants
- 963 patients
- Exposure
- Prosthesis-patient mismatch (PPM) vs no PPM after TAVR
- Outcome
- Prevalence and predictors of PPM; impact on mortality and clinical-echocardiographic progression of heart damage
- Follow-up
- 1 year
Methodological detailsinternational
- International
Main finding
As reported in the abstract
Prevalence of PPM
PPM after TAVR
18%
Severe PPM (whole cohort)
7.7%
Observational data: associations, not effects.
Further findings
Moderate-severe paravalvular AR · predischarge
P < 0.01
LV end-systolic diameter · 1 year
P = 0.03
Predictors of PPM
| OR (CI) | P value | ||
|---|---|---|---|
| Prosthesis size≤23 mmIndependent predictor | 11.6 (1.68–80.1) | ||
| SViProtective | 0.87 (0.83–0.91) | P < 0.001 | |
| LVOT diameterProtective | 0.79 (0.65–0.95) | P = 0.01 | |
| 0.050.21520Odds ratio (log scale) |
| Outcome | PPM | No PPM | P value |
|---|---|---|---|
| LV end-systolic indexed volume (moderate and severe PPM vs none) · 1 year | — not stated in the abstract | 44 (IQR 35–59) | P = 0.02 |
| NYHA III-IV (moderate/severe PPM vs none) · 1 year | — not stated in the abstract | 7.8% | P = 0.03 |
— not stated in the abstract
- LV end-systolic indexed volume (moderate and severe PPM vs none): Moderate PPM 52 (IQR 42–64)
- LV end-systolic indexed volume (moderate and severe PPM vs none): Severe PPM 52 (IQR 41–64)
- NYHA III-IV (moderate/severe PPM vs none): Moderate/severe PPM 13%
Overall and CV mortality
- No significant impact of PPM on overall mortality
- P = 0.71
- No significant impact of PPM on CV mortality
- P = 0.70
Original publication
Echocardiographic and clinical features of patients developing prosthesis‐patient mismatch after transcatheter aortic valve replacement: Insights from the Recovery-TAVR registry. Am Heart J. Published 3 June 2024. doi:10.
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