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. 2024 Oct 8;4(11):793-806.
doi: 10.1016/j.jacasi.2024.08.010. eCollection 2024 Nov.

Update on Prosthesis-Patient Mismatch Following Transcatheter Aortic Valve Replacement in Asian Patients

Kenichi Ishizu  1 , Kazuki Kitano  1 , Ko Yamamoto  1 , Masaomi Hayashi  1 , Shinichi Shirai  1 , Nobuhisa Ohno  2 , Shinichi Kakumoto  3 , Kenji Ando  1 , Fumiaki Yashima  4 , Hidetaka Nishina  5 , Masaki Izumo  6 , Masahiko Asami  7 , Norio Tada  8 , Masahiro Yamawaki  9 , Toru Naganuma  10 , Futoshi Yamanaka  11 , Yohei Ohno  12 , Hiroshi Ueno  13 , Masahiko Noguchi  14 , Kazuki Mizutani  15 , Kensuke Takagi  16 , Yusuke Watanabe  17 , Masanori Yamamoto  18   19   20 , Kentaro Hayashida  21 ; OCEAN-TAVI Investigators
Affiliations

Update on Prosthesis-Patient Mismatch Following Transcatheter Aortic Valve Replacement in Asian Patients

Kenichi Ishizu et al. JACC Asia. .

Abstract

Background: Prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) is of greater concern in Asians, considering their relatively smaller annular sizes compared with Westerners. However, the prognostic significance of PPM in Asian populations has not been demonstrated.

Objectives: This study aimed to elucidate the prognostic value of PPM after TAVR in Asian patients.

Methods: Patients undergoing TAVR from October 2013 to December 2019 were enrolled from the OCEAN-TAVI (Optimized CathEter vAlvular iNtervention-Transcatheter Aortic Valve Implantation) registry. PPM was classified based on the indexed effective orifice area as severe (≤0.65 cm2/m2) or moderate (0.66-0.85 cm2/m2) in the general population, and severe (≤0.55 cm2/m2) or moderate (0.56-0.70 cm2/m2) in the obese population (body mass index of ≥30 kg/m2).

Results: Of the 7,072 eligible patients, moderate and severe PPM were identified in 742 (10.5%) and 94 (1.3%) patients, respectively. Severe PPM relative to non-PPM was independently associated with higher adjusted risks for 3-year all-cause mortality (adjusted HR: 1.79; 95% CI: 1.16-2.78; P = 0.009) and heart failure hospitalization (adjusted HR: 1.88; 95% CI: 1.07-3.28; P = 0.027), whereas no significant difference in these outcomes was observed between moderate PPM and no PPM.

Conclusions: Severe PPM following TAVR was observed in only 1.3% of our Japanese cohort, but was associated with an increased risk of mortality and heart failure hospitalization at 3 years. These results warrant the implementation of preventive strategies to obviate severe PPM after TAVR, also in Asian patients.

Keywords: aortic stenosis; heart failure; long-term outcomes; prosthesis–patient mismatch; transcatheter aortic valve replacement.

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Conflict of interest statement

The OCEAN-TAVI registry is supported by Edwards Lifesciences, Medtronic, Boston Scientific, Abbott Medical, and Daiichi-Sankyo Company. Dr Izumo is a screening proctor for Edwards Lifesciences. Drs Yohei Ohno, Yashima, and Asami are clinical proctors for Medtronic. Drs Naganuma, Ueno, Mizutani, and Takagi are clinical proctors for Edwards Lifesciences and Medtronic. Drs Masanori Yamamoto, Shirai, Tada, Watanabe, and Hayashida are clinical proctors for Edwards Lifesciences, Abbott Medical, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Study Flowchart The flowchart provides information about the included and excluded patients. Based on the indexed effective orifice area, patients eligible for analysis were categorized into the following 5 groups: non-prosthesis–patient mismatch (PPM), moderate PPM, and severe PPM. SAVR = surgical aortic valve replacement; TAVI = transcatheter aortic valve implantation; THV = transcatheter heart valve; TTE = transthoracic echocardiography.
Central Illustration
Central Illustration
Incidence and Prognostic Impact of Prosthesis–Patient Mismatch Following Transcatheter Aortic Valve Replacement The incidence of prosthesis–patient mismatch (PPM) after transcatheter aortic valve replacement is shown in the left upper panel. The other panels show Kaplan-Meier curves for all-cause mortality, cardiovascular mortality, and heart failure hospitalization, respectively. The Kaplan-Meier curves were truncated at 3 years.
Figure 2
Figure 2
Spline Curves of Indexed EOA and Adjusted Risks for Outcomes Continuous relationships between indexed effective orifice area (EOA) and adjusted HR for (A) all-cause mortality, (B) cardiovascular mortality, and (C) heart failure hospitalization at 3 years, based on restricted cubic splines. The reference value of indexed EOA was set at 0.85 cm2/m2. In each panel, the solid line and the shaded area represent the HR and its 95% CI, respectively.
Figure 3
Figure 3
Subgroup Analysis of Association Between Severe PPM and 3-Year Mortality Forest plots for the adjusted HRs of 3-year all-cause mortality. To calculate HRs and interactions, we incorporated the risk-adjusting variables listed in Table 4. AF = atrial fibrillation; CFS = Clinical Frailty Scale; LVEF = left ventricular ejection fraction; PPM = prosthesis–patient mismatch; STS = Society of Thoracic Surgeons.
See this image and copyright information in PMC

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