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