The impact of prosthesis-patient mismatch on clinical outcomes in patients undergoing transcatheter aortic valve implantation

Abstract Background There is considerable debate on the impact of prosthesis-patient mismatch (PPM) after transcatheter aortic valve implantation (TAVI) on clinical outcomes. Objectives This study aimed to assess the impact of PPM after TAVI on clinical outcomes. Methods The current study population included 467 patients undergoing TAVI at our Hospital between 2014 and 2023. PPM was defined as moderate if ≥0.65 but <0.85 cm2/m2 (≥0.55 but <0.70 cm2/m2 if obese: body mass index>30 kg/m2) or severe if <0.65 cm2/m2 (<0.55 cm2/m2 if obese) at the indexed effective orifice area measured by transthoracic echocardiography at discharge. The primary outcome was a composite of all-cause death or heart failure hospitalization. Median follow-up duration was 2 years (Interquartile: 0.9 - 4.0 years). Results The median age of the current study population was 83.9 years. Moderate and severe PPM were seen in 78 (17%) and 11 (2%) patients, respectively. The factors associated with PPM included small valve size (SAPIEN 20 mm or CoreValve/Evolut 23 mm), balloon-expandable valves, and atrial fibrillation, but not post dilatation. There was no significant difference of the incidence of PPM between SAPIEN XT and SAPIEN 3 (21% and 21%, P= 0.98). PPM was not seen in SAPIEN 3 Ultra RESILIA (n= 0/10). The cumulative 3-year incidences of the primary outcome after TAVI were not significantly different between patients with and without PPM (22% and 27%, P= 0.42) (Figure 1 and 2). There was no significant difference of the primary outcome between patients with and without elevated (>20 mmHg) post-TAVI gradient (18% and 27%, P= 0.17). After adjusting confounders, the excess risk of PPM at discharge for the primary outcome was not significant (adjusted hazard ratio: 0.86, 95% confidence interval: 0.56-1.31, P= 0.48). Conclusions PPM was not associated with worse clinical outcomes in contemporary patients undergoing TAVI.Kaplan-Meier analysis and log-rank testcumulative incidence