Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada.
Cardiology Department, Expert Valve Center, Henri Mondor ho spital, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France.
Eur Heart J Cardiovasc Imaging. 2021 Jan 1;22(1):11-20. doi: 10.1093/ehjci/jeaa235.
The objective was to compare the incidence and impact on outcomes of measured (PPMM) vs. predicted (PPMP) prosthesis-patient mismatch following transcatheter aortic valve replacement (TAVR).
All consecutives patients who underwent TAVR between 2007 and 2018 were included. Effective orifice area (EOA) was measured by Doppler-echocardiography using the continuity equation and predicted according to the normal reference for each model and size of valve. PPM was defined using EOA indexed (EOAi) to body surface area as moderate if ≤0.85 cm2/m2 and severe if ≤ 0.65 cm2/m2 (respectively, ≤ 0.70 and ≤ 0.55 cm2/m2 if body mass index ≥ 30 kg/m2). The outcome endpoints were high residual gradient (≥20 mmHg) and the composite of cardiovascular mortality and hospital readmission for heart failure at 1 year. Overall, 1088 patients underwent a TAVR (55% male, age 79.1 ± 8.4 years, and STS score 6.6 ± 4.7%); balloon-expandable device was used in 83%. Incidence of moderate (10% vs. 27%) and severe (1% vs. 17%) PPM was markedly lower when defined by predicted vs. measured EOAi (P < 0.001). Balloon-expandable device implantation (OR: 1.90, P = 0.029) and valve-in-valve procedure (n = 118; OR: 3.21, P < 0.001) were the main factors associated with PPM occurrence. Compared with measured PPM, predicted PPM showed stronger association with high residual gradient. Severe measured or predicted PPM was not associated with clinical outcomes.
The utilization of the predicted EOAi reclassifies the majority of patients with PPM to no PPM following TAVR. Compared with measured PPM, predicted PPM had stronger association with haemodynamic outcomes, while both methods were not associated with clinical outcomes.
本研究旨在比较经导管主动脉瓣置换术（TAVR）后测量的（PPMM）与预测的（PPMP）人工假体-患者不匹配的发生率和对结局的影响。
纳入了 2007 年至 2018 年间接受 TAVR 的所有连续患者。有效瓣口面积（EOA）通过多普勒超声心动图使用连续方程进行测量，并根据每个瓣膜模型和大小的正常参考值进行预测。人工假体-患者不匹配（PPM）定义为 EOA 指数（EOAi）与体表面积的比值，如果≤0.85cm2/m2 为中度，如果≤0.65cm2/m2 为重度（如果 BMI≥30kg/m2，则分别为≤0.70 和≤0.55cm2/m2）。研究终点为残余梯度高（≥20mmHg）和 1 年时心血管死亡率和因心力衰竭再次住院的复合终点。总体而言，1088 例患者接受了 TAVR（55%为男性，年龄 79.1±8.4 岁，STS 评分 6.6±4.7%）；83%使用球囊扩张装置。与测量的 EOAi 相比，以预测的 EOAi 定义时，中度（10%比 27%）和重度（1%比 17%）人工假体-患者不匹配的发生率明显降低（P<0.001）。球囊扩张装置植入（OR：1.90，P=0.029）和瓣中瓣术（n=118；OR：3.21，P<0.001）是 PPM 发生的主要相关因素。与测量的 PPM 相比，预测的 PPM 与残余梯度高的相关性更强。严重的测量或预测的 PPM 与临床结局无关。
在 TAVR 后，预测的 EOAi 的使用将大多数 PPM 患者重新分类为无 PPM。与测量的 PPM 相比，预测的 PPM 与血液动力学结局的相关性更强，而这两种方法与临床结局均无关。
