Outcomes From Prosthesis–Patient Mismatch in TAVR Evaluated in TVT Registry

September 24, 2018—Findings on prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) were presented at TCT 2018, the 30th annual Transcatheter Cardiovascular Therapeutics scientific symposium held September 21–25 in San Diego, California, and simultaneously published online by Howard C. Herrmann, MD, et al in Journal of the American College of Cardiology (JACC).

The study utilized the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (TVT) registry to examine the frequency, predictors, and association with outcomes of PPM after TAVR in 62,125 patients enrolled between 2014 and 2017.

The investigators concluded that severe PPM after TAVR was present in 12% of patients and was associated with higher mortality and heart failure rehospitalization at 1 year. Further investigation is warranted into the prevention of severe PPM in patients undergoing TAVR.

As summarized in JACC, PPM was classified as severe (< 0.65 cm²/m²), moderate (0.65 to 0.85 cm²/m²), or none (> 0.85 cm²/m²) on the basis of the discharge echocardiographic effective valve area indexed to body surface area. Multivariable regression models were utilized to examine predictors of severe PPM as well as adjusted outcomes, including mortality, heart failure rehospitalization, stroke, and quality of life, at 1 year in 37,470 Medicare patients with claims linkage.

Severe and moderate PPM were present after TAVR in 12% and 25% of patients, respectively. Predictors of severe PPM included small (≤ 23 mm in diameter) valve prosthesis, valve-in-valve procedure, larger body surface area, female sex, younger age, nonwhite/Hispanic race, lower ejection fraction, atrial fibrillation, and severe mitral or tricuspid regurgitation.

At 1 year, mortality was 17.2%, 15.6%, and 15.9% in severe, moderate, and no PPM patients, respectively (P = .02). Heart failure rehospitalization had occurred in 14.7%, 12.8%, and 11.9% of patients with severe, moderate, and no PPM, respectively (P < .0001). There was no association of severe PPM with stroke or quality of life score at 1 year, reported the investigators in JACC and at TCT.