Valvular & structural heart diseaseCohort study
Measured Versus Predicted Prosthesis–Patient Mismatch after TAVR in Sievers Type 1 BAV: Incidence, Determinants, and Outcomes From the AD-HOC Registry
- retrospective, multicenter study
- 24 centers
Authors' conclusion
In patients with Sievers type 1 bicuspid aortic valve undergoing transcatheter aortic valve replacement, pPPM occurred less frequently than mPPM and was predominantly driven by anatomic characteristics and sizing strategies. Although pPPM was associated with increased all-cause mortality among patients with small annuli, this association did not extend to cardiovascular mortality and should be considered hypothesis-generating. Further prospective investigations are warranted to better delineate the impact of anatomic constraints on clinical outcomes in this anatomically challenging subset.
Study context
- Population
- Patients with severe aortic stenosis and Sievers type 1 bicuspid aortic valve treated with transcatheter aortic valve replacement between 2016 and 2023
- Participants
- 781 patients
- Exposure
- Measured versus predicted prosthesis-patient mismatch
- Outcome
- All-cause mortality
- Follow-up
- Mean 621±470 days
Main finding
As reported in the abstract
- neither mPPM nor pPPM was associated with mortality in the overall cohort
Observational data: associations, not effects.
Further findings
Moderate-to-severe PPM incidence
- Moderate-to-severe prosthesis-patient mismatch (PPM) incidence: P <0.001
Predictors of PPM
- Balloon-expandable valves were independently associated with both mPPM and pPPM
- smaller valve size and supra-annular sizing predicted only pPPM
pPPM in patients with a small annulus (≤430 mm 2 ; n=145)
- pPPM occurrence was significantly higher
- 19% versus 5.5%
- associated with increased all-cause mortality, but not with cardiovascular mortality
- P <0.001
- subgroup: small annulus (≤430 mm 2 ; n=145)
Original publication
Summarised from the published abstract; every number is checked against it