Measured Versus Predicted Prosthesis-Patient Mismatch after TAVR in Sievers Type 1 BAV: Incidence, Determinants, and Outcomes From the AD-HOC Registry.
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Fabris Tommaso, Arturi Federico, Buono Andrea, de Biase Chiara, Bellamoli Michele, Zito Andrea, Mangieri Antonio, Montarello Nicholas, Costa Giuliano, Alfadhel Mesfer, Koren Ofi, Fezzi Simone, Bellini Barbara, Massussi Mauro, Scotti Andrea, Bai Lin, Costa Giulia, Mazzapicchi Alessandro, Giacomin Enrico, Gorla Riccardo, Hug Karsten, Briguori Carlo, Bettari Luca, Messina Antonio, Boiago Mauro, Renker Matthias, Garcia Gomez Mario, Napodano Massimo, Fraccaro Chiara, Nai Fovino Luca, Masiero Giulia, Cardaioli Francesco, Putortì Francesco, Panza Andrea, De Rosa Maria Luisa, Trani Carlo, Laterra Giulia, Latini Alessia, Pellegrini Dario, Ielasi Alfonso, Orbach Ady, Landes Uri, Rheude Tobias, Testa Luca, Amat Santos Ignacio, Saia Francesco, Favero Luca, Cernetti Carlo, Chen Mao, Adamo Marianna, Latib Azeem, Petronio Anna Sonia, Montorfano Matteo, Makkar Raj R, Burzotta Francesco, Barbanti Marco, Blackman Daniel J, Mylotte Darren, De Backer Ole, Tchètchè Didier, Maffeo Diego, Kim Won-Keun, Tarantini Giuseppe
Аннотация
METHODS: The AD-HOC registry is a retrospective, multicenter study including 781 patients with severe aortic stenosis and bicuspid aortic valve treated with transcatheter aortic valve replacement between 2016 and 2023 across 24 centers. PPM was defined according to Valve Academic Research Consortium-3 criteria. The primary outcome was all-cause mortality.
RESULTS: Moderate-to-severe mPPM was more frequent than pPPM (22% versus 8%; P<0.001). Balloon-expandable valves were independently associated with both mPPM and pPPM, while smaller valve size and supra-annular sizing predicted only pPPM. During a mean follow-up of 621±470 days, neither mPPM nor pPPM was associated with mortality in the overall cohort. Among patients with a small annulus (≤430 mm2; n=145), pPPM occurrence was significantly higher (19% versus 5.5%; P<0.001) and was associated with increased all-cause mortality, but not with cardiovascular mortality.
CONCLUSIONS: 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.