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Meta-Analysis
. 2019 Jun 1;34(3):318-326.
doi: 10.21470/1678-9741-2019-0073.

Impact of Prosthesis-Patient Mismatch on 1-Year Outcomes after Transcatheter Aortic Valve Implantation: Meta-analysis of 71,106 Patients

Michel Pompeu Barros Oliveira Sá  1   2 , Luiz Rafael Pereira Cavalcanti  1   3 , Felipe Augusto Santos Sarargiotto  1   3 , Álvaro Monteiro Perazzo  1   3 , Sérgio da Costa Rayol  1   3 , Roberto Gouveia Silva Diniz  1   3 , Frederico Browne Correia Araújo Sá  1   3 , Alexandre Motta Menezes  1   3 , Ricardo Carvalho Lima  1   2
Affiliations
Meta-Analysis

Impact of Prosthesis-Patient Mismatch on 1-Year Outcomes after Transcatheter Aortic Valve Implantation: Meta-analysis of 71,106 Patients

Michel Pompeu Barros Oliveira Sá et al. Braz J Cardiovasc Surg. .

Abstract

Objectives: This study sought to evaluate the impact of prosthesis-patient mismatch (PPM) on the risk of early-term mortality after transcatheter aortic valve implantation (TAVI).

Methods: Databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], Cochrane Controlled Trials Register [CENTRAL/CCTR], ClinicalTrials.gov, Scientific Electronic Library Online [SciELO], Latin American and Caribbean Literature on Health Sciences [LILACS], and Google Scholar) were searched for studies published until February 2019. PPM after TAVI was defined as moderate if the indexed effective orifice area (iEOA) was between 0.85 cm2/m2 and 0.65 cm2/m2 and as severe if iEOA ≤ 0.65 cm2/m2.

Results: The search yielded 1,092 studies for inclusion. Of these, 18 articles were analyzed, and their data extracted. The total number of patients included who underwent TAVI was 71,106. The incidence of PPM after TAVI was 36.3% (25,846 with PPM and 45,260 without PPM). One-year mortality was not increased in patients with any PPM (odds ratio [OR] 1.021, 95% confidence interval [CI] 0.979-1.065, P=0.338) neither in those with moderate PPM (OR 0.980, 95% CI 0.933-1.029, P=0.423). Severe PPM was separately associated with high risk (OR 1.109, 95% CI 1.041-1.181, P=0.001).

Conclusion: The presence of severe PPM after TAVI increased early-term mortality. Although moderate PPM seemed harmless, the findings of this study cannot not rule out the possibility of it being detrimental, since there are other registries that did not address this issue yet.

Keywords: Aortic Stenosis; Heart Valve Prosthesis; Meta-Analysis; Prosthesis-Patient Mismatch; Transcatheter Aortic Valve Replacement.

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Conflict of interest statement

No conflict of interest.

Figures

Fig. 1
Fig. 1
Flow diagram of studies included in data search. CENTRAL/CCTR=Cochrane Controlled Trials Register; EMBASE=Excerpta Medica dataBASE; LILACS=Latin American and Caribbean Literature on Health Sciences; MEDLINE=Medical Literature Analysis and Retrieval System Online; PPM=prosthesis-patient mismatch; SAVR=surgical aortic valve replacement; SciELO=Scientific Electronic Library Online; TAVI=transcatheter aortic valve implantation
Fig. 2
Fig. 2
Odds ratio and conclusions plot of 1-year mortality for any prosthesis-patient mismatch (PPM). This figure shows the summary effect of no/any PPM on 1-year mortality. CI=confidence interval
Fig. 3
Fig. 3
Odds ratio and conclusions plot of 1-year mortality for moderate prosthesis-patient mismatch (PPM). This figure shows the summary effect of no versus moderate PPM on 1-year mortality. CI=confidence interval
Fig. 4
Fig. 4
Odds ratio and conclusions plot of 1-year mortality for severe prosthesis-patient mismatch (PPM). This figure shows the summary effect of no versus severe PPM on 1-year mortality. CI=confidence interval
Fig. 5
Fig. 5
Publication bias. Funnel plot analysis of the outcomes. PPM=prosthesis-patient mismatch.
See this image and copyright information in PMC

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