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Multicenter Study
. 2021 Feb 15;97(3):516-526.
doi: 10.1002/ccd.29227. Epub 2020 Aug 31.

Prevalence, predictors, and outcomes of patient prosthesis mismatch in women undergoing TAVI for severe aortic stenosis: Insights from the WIN-TAVI registry

Vasileios F Panoulas  1   2 , Jaya Chandrasekhar  3 , Gherardo Busi  4 , Neil Ruparelia  1 , Zhongjie Zhang  3 , Julinda Mehilli  5 , Samantha Sartori  3 , Thierre Lefèvre  6 , Patrizia Presbitero  7 , Piera Capranzano  8 , Didier Tchetche  9 , Alessandro Iadanza  10 , Gennaro Sardella  11 , Nicolas M Van Mieghem  12 , Emanuele Meliga  13 , Nicolas Dumonteil  9 , Chiara Fraccaro  14 , Daniela Trabattoni  15 , Samin Sharma  16 , Maria-Cruz Ferrer-Gracia  17 , Christoph K Naber  18 , Peter C Kievit  19 , Clayton Snyder  3 , Nilesh Sutaria  1 , Sayan Sen  1   2 , Iqbal S Malik  1   2 , Marie-Claude Morice  5 , Petros Nihoyannopoulos  1   2 , Anna Sonia Petronio  20 , Roxana Mehran  3 , Alaide Chieffo  4 , Ghada W Mikhail  1   2 ; WIN-TAVI Investigators
Affiliations
Multicenter Study

Prevalence, predictors, and outcomes of patient prosthesis mismatch in women undergoing TAVI for severe aortic stenosis: Insights from the WIN-TAVI registry

Vasileios F Panoulas et al. Catheter Cardiovasc Interv. .

Abstract

Objective: To evaluate the incidence, predictors and outcomes of female patients with patient-prosthesis mismatch (PPM) following transcatheter aortic valve intervention (TAVI) for severe aortic stenosis (AS).

Background: Female AS TAVI recipients have a significantly lower mortality than surgical aortic valve replacement (SAVR) recipients, which could be attributed to the potentially lower PPM rates. TAVI has been associated with lower rates of PPM compared to SAVR. PPM in females post TAVI has not been investigated to date.

Methods: The WIN-TAVI (Women's INternational Transcatheter Aortic Valve Implantation) registry is a multicenter registry of women undergoing TAVR for severe symptomatic AS. Two hundred and fifty patients with detailed periprocedural and follow-up echocardiographic investigations were included in the WIN-TAVI echocardiographic sub-study. PPM was defined as per European guidelines stratified by the presence of obesity.

Results: The incidence of PPM in our population was 32.8%. Patients with PPM had significantly higher BMI (27.4 ± 6.1 vs. 25.2 ± 5.0, p = .002), smaller sized valves implanted (percentage of TAVI ≤23 mm 61% vs. 29.2%, PPM vs. no PPM, p < .001) and were more often treated with balloon expandable valves (48.3 vs. 32.5%, p < .001) rather than self expanding ones (26.3 vs. 52.8%, <.001). BMI (OR = 1.08; 95%CI 1.02-1.14, p = .011) and valve size ≤23 mm (OR = 3.00 95%CI 1.14-7.94, p = .027) were the only independent predictors of PPM. There was no significant interaction between valve size and valve type (p = .203). No significant differences were observed in 1-year mortality or major adverse cardiovascular events.

Conclusions: PPM in females undergoing TAVI occurs in one third of patients. BMI and valve size ≤23 mm are independent predictors. Larger registries are required to determine the impact of PPM on future clinical outcomes.

Keywords: TAVI; females; outcomes; patient-prosthesis mismatch.

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References

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