Prosthesis-Patient Mismatch in Young and Low-Risk Patients After Newer Generation Balloon-Expandable Transcatheter Aortic Valve Replacement.

BACKGROUND

The clinical impact of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) is not well known in young and low-risk patients.

OBJECTIVES

The aim of this single-center study was to evaluate the incidence, predictors, and long-term impact of PPM in young and low-risk patients with severe native aortic stenosis (AS) following TAVR.

METHODS

From August 2015 to December 2022, a total of 3,549 patients underwent TAVR with newer generation balloon-expandable valves. Among them, 512 patients with severe native AS who were younger than 75 years and had Society of Thoracic Surgeons scores <4% were included. All-cause and cardiovascular mortality or heart failure hospitalization during follow-up period were compared between the PPM and non-PPM groups. PPM was defined according to the Valve Academic Research Consortium-3 criteria.

RESULTS

PPM was observed in 200 of 512 patients (39.0%), with moderate and severe PPM in 162 of 512 (31.6%) and 38 of 512 (7.4%), respectively. Younger age, female sex, larger body surface area, no balloon postdilation, and smaller annular area were independent predictors of PPM. Over a median follow-up duration of 1,034 days (Q1-Q3: 550-1,567 days), compared with the non-PPM group, the PPM group had significantly higher all-cause mortality (HR: 2.55; 95% CI: 1.3-5.0; P = 0.007), cardiovascular mortality (HR: 2.81; 95% CI: 1.1-7.5; P = 0.04), and heart failure hospitalization (HR: 4.43; 95% CI: 2.0-9.9; P < 0.001).

CONCLUSIONS

PPM is associated with worse clinical outcomes in young and low-risk patients with AS after TAVR, even with newer generation balloon-expandable valves.