Author + information
- Received August 3, 2018
- Revision received September 3, 2018
- Accepted September 3, 2018
- Published online November 26, 2018.
- Howard C. Herrmann, MDa,∗ (, )@Penn@gcfmd,
- Samuel A. Daneshvar, MDb,
- Gregg C. Fonarow, MDb,
- Amanda Stebbins, MPHc,
- Sreekanth Vemulapalli, MDc,
- Nimesh D. Desai, MDa,
- David J. Malenka, MDd,
- Vinod H. Thourani, MDe,
- Jennifer Rymer, MDc and
- Andrzej S. Kosinski, PhDc
- aPerelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- bUniversity of California Los Angeles, Los Angeles, California
- cDuke Clinical Research Institute, Durham, North Carolina
- dDartmouth-Hitchcock, Lebanon, New Hampshire
- eMedStar Heart and Vascular Institute and Georgetown University, Washington, DC
- ↵∗Address for correspondence:
Dr. Howard C. Herrmann, University of Pennsylvania, PCAM South Pavilion 11-107, 3400 Civic Center Boulevard, Philadelphia, Pennsylvania 19104.
Background Prosthesis–patient mismatch (PPM) after surgical aortic valve replacement (AVR) for aortic stenosis is generally associated with worse outcomes. Transcatheter AVR (TAVR) can achieve a larger valve orifice and the effects of PPM after TAVR are less well studied.
Objectives The authors utilized the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) registry to examine the frequency, predictors, and association with outcomes of PPM after TAVR in 62,125 patients enrolled between 2014 and 2017.
Methods On the basis of the discharge echocardiographic effective valve area indexed to body surface area, PPM was classified as severe (<0.65 cm2/m2), moderate (0.65 to 0.85 cm2/m2), or none (>0.85 cm2/m2). Multivariable regression models were utilized to examine predictors of severe PPM as well as adjusted outcomes, including mortality, heart failure (HF) rehospitalization, stroke, and quality of life, at 1 year in 37,470 Medicare patients with claims linkage.
Results Severe and moderate PPM were present following TAVR in 12% and 25% of patients, respectively. Predictors of severe PPM included small (≤23-mm diameter) valve prosthesis, valve-in-valve procedure, larger body surface area, female sex, younger age, non-white/Hispanic race, lower ejection fraction, atrial fibrillation, and severe mitral or tricuspid regurgitation. At 1 year, mortality was 17.2%, 15.6%, and 15.9% in severe, moderate, and no PPM patients, respectively (p = 0.02). HF rehospitalization had occurred in 14.7%, 12.8%, and 11.9% of patients with severe, moderate, and no PPM, respectively (p < 0.0001). There was no association of severe PPM with stroke or quality-of-life score at 1 year.
Conclusions Severe PPM after TAVR was present in 12% of patients and was associated with higher mortality and HF rehospitalization at 1 year. Further investigation is warranted into the prevention of severe PPM in patients undergoing TAVR.
Dr. Herrmann has received institutional research funding from Abbott Vascular, Bayer, Boston Scientific, Edwards Lifesciences, Medtronic, and St. Jude Medical; and has been a consultant for Edwards Lifesciences, Medtronic, and Siemens Healthineers. Dr. Fonarow has been a consultant for Abbott Vascular and Medtronic. Dr. Vemulapalli has received research grants from Abbott Vascular; and has received research grants, consulting fees, and speaker fees from Boston Scientific. Dr. Desai has received institutional research funding from Abbott Vascular, Medtronic, and Gore; and has been a consultant for Edwards Lifesciences, Medtronic, Abbott Vascular, and Gore. Dr. Thourani has been a consultant for Abbott Vascular, Boston Scientific, Edwards Lifesciences, and Gore Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 3, 2018.
- Revision received September 3, 2018.
- Accepted September 3, 2018.
- 2018 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.