Effects of prosthesis-patient mismatch on cardiac function and clinical outcome after transcatheter aortic valve implantation

Abstract Background Transcatheter aortic valve implantation (TAVI) prostheses have better hemodynamics compared to surgical prostheses, with a lower incidence of prosthesis-patient mismatch (PPM). Nonetheless, the effects of PPM have been controversial regarding clinical impact. This study aims to determine the short-term impact of PPM on cardiac function and the effect of PPM on mid-term outcome in patients undergoing transfemoral TAVI with balloon-expandable valves. Methods One hundred sixty consecutive patients (76.5±7.4 years, 85 men) were enrolled and examined before and 30 days after TAVI, by comprehensive echocardiogram (speckle tracking echocardiography and strain analysis). Patients were divided according to measured PPM (PPM M ) into PPM M group: indexed effective orifice area (EOAi)≤0.85 cm 2 /m 2 (n=64), and No-PPM M group: EOAi>0.85 cm 2 /m 2 (n=96). Predictors and predictive value of PPM M were analyzed based on the primary endpoint, 3-year all-cause mortality. Results Impaired LA function was independently associated with PPM M after TAVI (global LA strain - OR 0.92, p = 0.022). Three-year mortality was higher in the PPM M group (23.4% vs. 10.4% in the No-PPM M group, p=0.026). Conclusions Our study revealed significantly worse impairment of LA function in patients with PPM M compared to those without PPM M on short-term follow-up, which correlated with 3-year mortality.