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Observational Study
. 2025 Feb 24;18(4):492-502.
doi: 10.1016/j.jcin.2024.10.002. Epub 2025 Jan 8.

Incidence and Prognosis of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement for Bicuspid Aortic Stenosis

Futoshi Yamanaka  1 , Koki Shishido  2 , Noriaki Moriyama  2 , Tomoki Ochiai  2 , Hirokazu Miyashita  2 , Hiroaki Yokoyama  2 , Yoichi Sugiyama  2 , Fumiaki Yashima  3 , Yohei Ohno  4 , Hidetaka Nishina  5 , Masaki Izumo  6 , Masahiko Asami  7 , Toru Naganuma  8 , Kazuki Mizutani  9 , Masahiro Yamawaki  10 , Norio Tada  11 , Shinichi Shirai  12 , Masahiko Noguchi  13 , Hiroshi Ueno  14 , Kensuke Takagi  15 , Yusuke Watanabe  16 , Masanori Yamamoto  17 , Shigeru Saito  2 , Kentaro Hayashida  18 ; OCEAN-TAVI Investigators
Affiliations
Observational Study

Incidence and Prognosis of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement for Bicuspid Aortic Stenosis

Futoshi Yamanaka et al. JACC Cardiovasc Interv. .

Abstract

Background: Evidence regarding the incidence of prosthesis-patient mismatch (PPM) and long-term mortality after transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve stenosis (AS) is scarce.

Objectives: This study sought to assess the incidence and prognostic impact of PPM after TAVR for bicuspid AS compared with that for tricuspid AS.

Methods: In total, 7,393 patients who underwent TAVR were prospectively enrolled in the OCEAN-TAVI (Optimized Catheter Valvular Intervention Transcatheter Aortic Valve Implantation) registry, an ongoing Japanese, multicenter registry. We analyzed 7,051 patients (median age = 85 years, 68.4% women) and identified 503 (7.1%) with bicuspid AS. We compared the incidence of PPM and long-term mortality in 497 patients with and 497 without bicuspid AS after one-to-one propensity score matching analysis.

Results: Among the 7,051 patients, moderate and severe PPM were observed in 756 (10.7%) and 92 (1.3%) patients, respectively. Upon Kaplan-Meier curve analysis of the overall cohort, severe PPM appeared to be associated with long-term mortality (log-rank test, P = 0.065). After propensity score matching analysis, moderate and severe PPM were more frequently observed among patients with tricuspid AS than patients with bicuspid AS (moderate PPM, 11.7% vs 4.4%; severe PPM, 1.4% vs 1.0%; P = 0.0001).

Conclusions: Severe PPM appeared to be associated with all-cause mortality. Moderate and severe PPM were more frequently observed in patients with tricuspid AS than patients with bicuspid AS.

Keywords: all-cause mortality; bicuspid aortic valve; long-term mortality; prosthesis-patient mismatch; transcatheter aortic valve replacement.

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Conflict of interest statement

Funding Support and Author Disclosures The OCEAN-TAVI registry is supported by Edwards Lifesciences, Medtronic, Boston Scientific, Abbott Medical, and Daiichi-Sankyo Company. Dr Yashima is a clinical proctor for Medtronic. Dr Ohno is a clinical proctor for Medtronic. Dr Izumo is a screening proctor for Edwards Lifesciences. Dr Asami is a clinical proctor for Medtronic. Dr Naganuma is a clinical proctor for Edwards Lifesciences and Medtronic. Dr Takagi is a clinical proctor for Edwards Lifesciences and Medtronic. Dr Mizutani is a clinical proctor for Edwards Lifesciences and Medtronic. Dr Tada is a clinical proctor for Edwards Lifesciences, Abbott Medical, and Medtronic. Dr Shirai is a clinical proctor for Edwards Lifesciences, Abbott Medical, and Medtronic. Dr Ueno is a clinical proctor for Edwards Lifesciences and Medtronic. Dr Watanabe is a clinical proctor for Edwards Lifesciences, Abbott Medical, and Medtronic. Dr Yamamoto is a clinical proctor for Edwards Lifesciences, Abbott Medical, and Medtronic. Dr Hayashida is a clinical proctor 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.

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