Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany.
Department of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Kiel, Germany.
Clin Res Cardiol. 2019 Jun;108(6):660-668. doi: 10.1007/s00392-018-1394-0. Epub 2018 Nov 19.
The implications of prosthesis-patient mismatch (PPM) in the context of transcatheter aortic valve implantation (TAVI) are still controversial. The objective of our study was thus to investigate the incidence and prognostic impact of PPM after TAVI.
Our analysis included 613 TAVI patients in whom the indexed effective orifice area (iEOA) after TAVI was obtained in vivo using echocardiography. Prosthesis sizing was guided by pre-procedural ECG-gated computed tomography. Based on VARC-2 established criteria for significant PPM (iEOA ≤ 0.85 cm/m in the setting of BMI < 30 kg/m and iEOA ≤ 0.7 cm/m in the context of BMI ≥ 30 kg/m), patients were attributed to a "No PPM" or a "PPM" group.
We observed PPM after TAVI in 192 patients (31.3%) with moderate PPM being present in 150 subjects (24.5%) and severe PPM in 42 patients (6.9%). EuroSCORE, impaired LV function, and male gender were associated with PPM status. The "No PPM" group was characterized by higher rates of self-expandable valves (40.4% vs. 25.5%, p < 0.001). In a multivariate analysis age > 81.2 years, chronic obstructive pulmonary disease, peripheral artery disease, impaired LV function, acute kidney failure stage 3 as well as periprocedural myocardial infarction emerged as independent risk predictors for all-cause mortality after TAVI. After a median follow-up of 12.2 months PPM failed to show a significant association with overall survival (79.2% vs. 79.3%, p = 0.692).
The incidence of PPM after TAVI seems to be substantially lower than after SAVR. PPM was less common using self-expandable valves. In our analysis, patients with PPM following TAVI did not have higher rates of all-cause mortality.
在经导管主动脉瓣置换术（TAVI）背景下，假体-患者不匹配（PPM）的影响仍存在争议。因此，我们的研究目的是调查 TAVI 后 PPM 的发生率和预后影响。
我们的分析纳入了 613 名 TAVI 患者，这些患者在 TAVI 后通过超声心动图在体内获得了指数有效瓣口面积（iEOA）。假体大小由术前心电图门控计算机断层扫描指导。根据 VARC-2 确定的严重 PPM 标准（BMI<30kg/m 时 iEOA≤0.85cm/m，BMI≥30kg/m 时 iEOA≤0.7cm/m），患者被分为“无 PPM”或“PPM”组。
我们观察到 192 名患者（31.3%）在 TAVI 后存在 PPM，其中 150 名患者（24.5%）存在中度 PPM，42 名患者（6.9%）存在严重 PPM。EuroSCORE、左心室功能障碍和男性与 PPM 状态相关。“无 PPM”组的自膨式瓣膜比例较高（40.4% vs. 25.5%，p<0.001）。多变量分析显示，年龄>81.2 岁、慢性阻塞性肺疾病、外周动脉疾病、左心室功能障碍、急性肾损伤 3 期以及围手术期心肌梗死是 TAVI 后全因死亡率的独立危险因素。中位随访 12.2 个月后，PPM 与总生存率之间未显示出显著相关性（79.2% vs. 79.3%，p=0.692）。
TAVI 后 PPM 的发生率似乎明显低于 SAVR。自膨式瓣膜的 PPM 较少见。在我们的分析中，TAVI 后存在 PPM 的患者全因死亡率没有更高。
