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Impact of Severe Patient-Prosthesis Mismatch and Its Effect on Long-Term Survival After TAVI

https://doi.org/10.1007/s00392-025-02625-4

Johanna Bormann (Bad Oeynhausen)1, V. Rajgopal (Bad Oeynhausen)1, I. Horn (Bad Oeynhausen)2, S. Waezsada (Bad Oeynhausen)2, J. Kirchner (Bad Oeynhausen)1, F. Rudolph (Bad Oeynhausen)1, S. Bleiziffer (Bad Oeynhausen)3, V. Rudolph (Bad Oeynhausen)1, T. K. Rudolph (Bad Oeynhausen)1, M. Gercek (Bad Oeynhausen)1

1Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; 2Herz- und Diabeteszentrum NRW Klinik für Kardiologie Bad Oeynhausen, Deutschland; 3Herz- und Diabeteszentrum NRW Klinik für Thorax- und Kardiovaskularchirurgie Bad Oeynhausen, Deutschland

 

Aim:

Patient-prosthesis mismatch (PPM) is associated with impaired hemodynamics in patients with surgical aortic valve replacement (SAVR); however, its impact on long-term mortality in transcatheter aortic valve implantation (TAVI) patients remains controversial. This study aims to investigate long-term mortality in TAVI-patients with severe measured PPM compared to those without relevant measured PPM.

 

Methods:  

A retrospective analysis was conducted on all consecutive patients who underwent TAVI between 2017 and 2022 at Heart- and Diabetes Center NRW (HDZ NRW, Bad Oeynhausen). Patients with missing echocardiography data or those who underwent a valve-in-valve (ViV) procedure were excluded from the study. Severe PPM was defined according to VARC-3 criteria as either ≤0.65 cm²/m² or ≤0.55 cm²/m² for patients with a body mass index (BMI) of ≥30 kg/m². Patients with no or mild PPM were categorized as having non-relevant measured PPM.

 

Results:

A total of 2,567 TAVI patients were included in the final analysis, with a mean age of 82 years. 51.03% of the patients were female. Mild PPM was observed in 21.5% of the patients while 4.4% had severe measured PPM. Patients with severe PPM exhibited significantly higher maximum and mean pressure gradients post-TAVI. Additionally, balloon-expandable valves with smaller device sizes were more frequently used in this group. Over a follow-up period of up to 60 months (median 19.7 months, interquartile range 7.4-36.3 months), mortality was significantly higher among patients with severe measured PPM, showing a rate of 31.86%, compared to 20.99% in the non-relevant PPM group (p=0.009). Kaplan-Meier survival analysis confirmed that patients with severe PPM had significantly lower survival rates, with a log-rank p-value of 0.022.

 

Conclusion:

Careful planning of the TAVI procedure, including optimal selection of the prosthesis, is crucial for improving patient outcomes as patients with severe measured PPM demonstrated a significantly higher all-cause mortality rate.




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