Al-Azizi Karim, Pickering Taylor, AboHajar Mohamad Bader, Moubarak Ghadi, Mohiuddin Asim, Potluri Srinivasa P, Thomas Sibi, Baig Imran, Aqtash Obadah, Trehan Sanjeev, Harrington Katherine B, Schaffer Justin M, Brinkman William T, Alsaid Amro, Wang Zuyue, Ladner Jonathan, Gunukula Rahul, Parro Colleen, Prasad Tanushree, Stoler Robert, Chugh Yashasvi, Banerjee Subhash, Mixon Timothy, Widmer Robert J, Caldera Angel, Contreras Jose Condado, Krueger Anita, Reddy Manne Janaki Rami, Phatak Prajakta, Matar Ralph M, Gray William, DiMaio J Michael, Mack Michael J, Szerlip Molly
Department of Cardiology, Baylor Scott & White The Heart Hospital, Plano, Texas.
Baylor Scott & White Research Institute, Plano, Texas.
J Soc Cardiovasc Angiogr Interv. 2025 May 1;4(7):103621. doi: 10.1016/j.jscai.2025.103621. eCollection 2025 Jul.
Prosthesis-patient mismatch (PPM) remains a topic of controversy in patients undergoing transcatheter aortic valve replacement (TAVR), particularly among women with smaller annuli. Although self-expanding valves (SEV) appear to provide superior hemodynamic performance than balloon-expandable valves, the impact of PPM severity on long-term survival, particularly regarding sex-specific differences, remains inadequately characterized.
This retrospective cohort study analyzed 3016 patients (1338 women) who underwent native valve TAVR from 2012 to 2021. Patients were stratified by sex, valve type (balloon-expandable valve vs SEV), and PPM predicted (PPM) and measured (PPM) severity as defined by the Valve Academic Research Consortium. The primary outcome was all-cause mortality at 5 years, with secondary outcomes including PPM incidence, severity, and residual transvalvular gradients.
Women exhibited higher rates of severe PPM (1.7% vs 0.1%; < .001) and severe PPM (7.3% vs 5.4%; = .033). Notably, neither moderate nor severe PPM or PPM adversely affected 5-year survival in women (severe PPM hazard ratio [HR], 1.24; = .709; severe PPM HR, 1.35; = .168). SEVs were associated with lower overall PPM (12.8% vs 31.8%) and PPM (16.1% vs 31.1%) and superior hemodynamics. Although SEVs demonstrated a nonsignificant lower unadjusted survival (44.4% vs 38.0%; = .286), 5-year survival was similar within PPM strata after risk adjustment (overall PPM HR, 0.51; = .510; overall PPM HR, 0.77; = .412).
Despite a higher incidence and severity of both PPM and PPM, women did not experience decreased long-term survival after TAVR. Additionally, there was no risk-adjusted survival difference between valve types, emphasizing the need for individualized prosthesis selection and lifetime valve management considerations.
在接受经导管主动脉瓣置换术（TAVR）的患者中，人工瓣膜-患者不匹配（PPM）仍是一个存在争议的话题，尤其是在瓣环较小的女性患者中。尽管自膨胀瓣膜（SEV）似乎比球囊扩张瓣膜具有更好的血流动力学性能，但PPM严重程度对长期生存的影响，特别是性别差异方面，仍未得到充分描述。
这项回顾性队列研究分析了2012年至2021年期间接受初次瓣膜TAVR的3016例患者（1338例女性）。患者按性别、瓣膜类型（球囊扩张瓣膜与SEV）以及瓣膜学术研究联盟定义的预测PPM（PPM）和测量PPM（PPM）严重程度进行分层。主要结局是5年全因死亡率，次要结局包括PPM发生率、严重程度和残余跨瓣压差。
女性患者中重度PPM（1.7%对0.1%；P<0.001）和重度PPM（7.3%对5.4%；P = 0.033）的发生率更高。值得注意的是，中度或重度PPM或PPM均未对女性患者的5年生存率产生不利影响（重度PPM风险比[HR]，1.24；P = 0.709；重度PPM HR，1.35；P = 0.168）。SEV与总体较低的PPM（12.8%对31.8%）和PPM（16.1%对31.1%）以及更好的血流动力学相关。尽管SEV的未调整生存率略低（44.4%对38.0%；P = 0.286），但风险调整后PPM分层内的5年生存率相似（总体PPM HR，0.51；P = 0.510；总体PPM HR，0.77；P = 0.412）。
尽管PPM和PPM的发生率和严重程度较高，但女性患者在TAVR后并未出现长期生存率下降。此外，瓣膜类型之间在风险调整后的生存率无差异，强调了个体化人工瓣膜选择和终身瓣膜管理考虑的必要性。
