Measured Versus Predicted Prosthesis–Patient Mismatch after TAVR in Sievers Type 1 BAV: Incidence, Determinants, and Outcomes From the AD-HOC Registry

BACKGROUND: Evidence regarding prosthesis-patient mismatch (PPM), measured (mPPM), and predicted (pPPM), after transcatheter aortic valve replacement in bicuspid aortic valve stenosis remains limited. This study sought to evaluate the incidence, predictors, and prognostic implications of mPPM and pPPM in patients with Sievers type 1 bicuspid aortic valve undergoing transcatheter aortic valve replacement. 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: <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.

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Journal
Circulation Cardiovascular Interventions
Published
2026-05-12
DOI
https://doi.org/10.1161/circinterventions.125.015994
Primary Topic
Cardiac Valve Diseases and Treatments
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article
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article

Measured Versus Predicted Prosthesis–Patient Mismatch after TAVR in Sievers Type 1 BAV: Incidence, Determinants, and Outcomes From the AD-HOC Registry

Diego Maffeo, Enrico Giacomin, Uri Landes, Alessandro Mazzapicchi et al.
Circulation Cardiovascular Interventions
Cardiac Valve Diseases and Treatments
article

Measured Versus Predicted Prosthesis–Patient Mismatch after TAVR in Sievers Type 1 BAV: Incidence, Determinants, and Outcomes From the AD-HOC Registry

Diego Maffeo, Enrico Giacomin, Uri Landes, Alessandro Mazzapicchi, Giulia Laterra, Luca Bettari, Federico Arturi, Massimo Napodano, Mauro Boiago, Alfonso Ielasi, Michele Bellamoli, Andrea Panza, Riccardo Gorla, Luca Nai Fovino, Simone Fezzi, Carlo Cernetti, Maria Luisa De Rosa, Ady Orbach, Francesco Cardaioli, Carlo Briguori, Mesfer Alfadhel, Ignacio Amat Santos, R Makkar, T Rheude, O Koren, M Renker, M Adamo, B Bellini, F Burzotta, M Montorfano, C Trani, M L Chen, Luca Favero, Karsten Hug, Antonio Mangieri, Mario Garcia Gomez, Daniel J. Blackman, Tommaso Fabris, Mauro Massussi, Giuseppe Tarantini, Dario Pellegrini, Giulia Masiero, Chiara Fraccaro, Azeem Latib, Lin Bai, Ole De Backer, Nicholas Montarello, Antonio Messina, Chiara de Biase, Anna Sonia Petronio, Francesco Saia, Won-Keun Kim, Didier Tchètchè, Francesco Putortì, Andrea Scotti, Luca Testa, Alessia Latini, Giuliano Costa, Marco Barbanti, Giulia Costa, Andrea Buono, Darren Mylotte, Andrea Zito
article en

Abstract

BACKGROUND: Evidence regarding prosthesis-patient mismatch (PPM), measured (mPPM), and predicted (pPPM), after transcatheter aortic valve replacement in bicuspid aortic valve stenosis remains limited. This study sought to evaluate the incidence, predictors, and prognostic implications of mPPM and pPPM in patients with Sievers type 1 bicuspid aortic valve undergoing transcatheter aortic valve replacement. 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: <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.

Circulation Cardiovascular Interventions
Montefiore Medical Center (US), Vita-Salute San Raffaele University (IT), Tel Aviv University (IL), Sichuan University (CN), Università degli Studi di Enna Kore (IT), Leeds Teaching Hospitals NHS Trust (GB), Wolfson Medical Center (IL), Copenhagen University Hospital (DK), University Hospital Galway (IE), Rigshospitalet (DK), San Raffaele University of Rome (IT), West China Hospital of Sichuan University (CN), Ferioli & Gianotti (Italy) (IT), IRCCS Policlinico San Donato (IT), Istituto Clinico Sant'Ambrogio (IT), Azienda USL di Bologna (IT), Clinica Mediterranea (IT), Policlinico Universitario di Catania (IT), Kerckhoff Klinik (DE), Clinique Pasteur (FR), Cedars-Sinai Smidt Heart Institute (US), Ca' Foncello Hospital (IT), Fondazione Poliambulanza Istituto Ospedaliero (IT), Deutsches Herzzentrum München (DE), University of the Sacred Heart (JP), Hospital Clínico Universitario de Valladolid (ES), IRCCS Humanitas Research Hospital (IT), Azienda Ospedaliera Universitaria Pisana (IT), University of Brescia (IT)
Good health and well-being
Openalex Percentile: Top 7%
Cardiac Valve Diseases and Treatments
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