Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2026
Long-Term Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement in Patients With Small Aortic Annuli.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Loewenstein Itamar, Gitter Bar, Itach Tamar, Arbel Yaron, Ben-Shoshan Jeremy, Konigstein Maayan, Finkelstein Ariel, Halkin Amir, Banai Shmuel, Steinvil Arie
Аннотация
BACKGROUND: Prosthesis-patient mismatch (PPM) remains common following transcatheter aortic valve replacement (TAVR) and is associated with worse clinical outcomes. PPM is of particular concern in small aortic annuli (SAA).
AIMS: To compare the incidence, predictors, and long-term impact of PPM in SAA TAVR.
METHODS: Single-center retrospective registry analysis of native, severe aortic stenosis patients with computed tomography-derived annulus area ≤ 430 mm², undergoing TAVR via transfemoral access. Significant PPM was defined as moderate and above and classified by the Valve Academic Research Consortium (VARC)-3. Additional analyses were conducted for predicted PPM and gender-based criteria. Inverse probability treatment weighting (IPTW) was applied to identify predictors of significant PPM and long-term mortality.
RESULTS: The cohort included 631 consecutive patients with SAA undergoing TAVR between 2015 and 2024. Significant PPM occurred in 23.3%. Multivariable analyses identified BEV implantation (OR 2.1, 95% CI 1.3-4.9, p < 0.001) and larger body surface area (OR 4.6, 95% CI 1.7-18.8, p < 0.001) as independent predictors of PPM. Large annulus perimeter had a protective association (OR 0.85, 95% CI 0.79-0.91, p < 0.001). Five-year mortality was significantly higher among patients with significant PPM (32.0% vs. 25.4%; log-rank p = 0.008). Age (HR 1.04, 95% CI 1.004-1.07, p = 0.03), moderate and above paravalvular leak (HR 3.25, 95% CI 1.3-8.0, p = 0.01), and significant PPM (HR 1.97, 95% CI 1.2-3.1, p = 0.004) were independently associated with 5-year mortality.
CONCLUSIONS: Significant PPM remains highly prevalent following SAA TAVR. BEV implantation and larger BSA were associated with significant PPM, and a larger implanted valve had a protective association. Significant PPM is independently associated with long-term mortality.
AIMS: To compare the incidence, predictors, and long-term impact of PPM in SAA TAVR.
METHODS: Single-center retrospective registry analysis of native, severe aortic stenosis patients with computed tomography-derived annulus area ≤ 430 mm², undergoing TAVR via transfemoral access. Significant PPM was defined as moderate and above and classified by the Valve Academic Research Consortium (VARC)-3. Additional analyses were conducted for predicted PPM and gender-based criteria. Inverse probability treatment weighting (IPTW) was applied to identify predictors of significant PPM and long-term mortality.
RESULTS: The cohort included 631 consecutive patients with SAA undergoing TAVR between 2015 and 2024. Significant PPM occurred in 23.3%. Multivariable analyses identified BEV implantation (OR 2.1, 95% CI 1.3-4.9, p < 0.001) and larger body surface area (OR 4.6, 95% CI 1.7-18.8, p < 0.001) as independent predictors of PPM. Large annulus perimeter had a protective association (OR 0.85, 95% CI 0.79-0.91, p < 0.001). Five-year mortality was significantly higher among patients with significant PPM (32.0% vs. 25.4%; log-rank p = 0.008). Age (HR 1.04, 95% CI 1.004-1.07, p = 0.03), moderate and above paravalvular leak (HR 3.25, 95% CI 1.3-8.0, p = 0.01), and significant PPM (HR 1.97, 95% CI 1.2-3.1, p = 0.004) were independently associated with 5-year mortality.
CONCLUSIONS: Significant PPM remains highly prevalent following SAA TAVR. BEV implantation and larger BSA were associated with significant PPM, and a larger implanted valve had a protective association. Significant PPM is independently associated with long-term mortality.