Incidence, Predictors, and Clinical Impact of Prosthesis-Patient Mismatch Following Transcatheter Aortic Valve Replacement in Asian Patients: The OCEAN-TAVI Registry

Abstract

Objectives: The authors sought to investigate the prevalence, risk factors, and mid-term mortality in Asian patients with prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR).

Background: Little information is available on PPM after TAVR in Asian patients.

Methods: The authors included 1,558 patients enrolled in the OCEAN-TAVI (Optimized transCathEter vAlvular iNtervention) Japanese multicenter registry from October 2013 to July 2016 after excluding patients who died following TAVR before discharge. PPM was defined as moderate if ≧0.65 but ≦0.85 cm²/m², or severe if <0.65 cm²/m² at the indexed effective orifice area by post-procedural echocardiography.

Results: Of the 1,546 patients, moderate and severe PPM were observed in 138 (8.9%) and 11 (0.7%) patients, respectively. These 149 patients were included in the PPM group. The median age and body surface area were 85 years (interquartile range [IQR]: 81 to 88 years) and 1.41 m² (IQR: 1.30 to 1.53 m²), respectively. In our multivariate analysis, younger age, larger body surface area, smaller aortic valve area, smaller annulus area, no balloon post-dilatation, and use of Edwards Sapien 3 (Edwards Lifesciences, Irvine, California) were identified as independent predictors of PPM. The estimated cumulative all-cause mortality at 1 year using the Kaplan-Meier method was similar between the PPM and non-PPM groups (10.2% vs. 8.3%; log-rank; p = 0.41).

Conclusions: The low prevalence of PPM and mortality at 1 year in patients with PPM after TAVR in this Japanese cohort implies that PPM is not a risk factor for mid-term mortality in Asian patients who have undergone TAVR.

Keywords: PPM; TAVR; body surface area; clinical outcome; small body size.