Impact of prosthesis-iteration evolution and sizing practice on the incidence of prosthesis–patient mismatch after transcatheter aortic valve replacement

Mohammad Abdelghani, Abdelhakim Allali, Jatinderjit Kaur, Rayyan Hemetsberger, Julinda Mehilli, Franz Josef Neumann, Christian Frerker, Thomas Kurz, Mohamed El-Mawardy, Gert Richardt, Mohamed Abdel-Wahab*

*Korrespondierende/r Autor/-in für diese Arbeit
15 Zitate (Scopus)

Abstract

Objectives: To investigate the impact of the introduction of the next generation self-expanding (SE) and balloon-expandable (BE) transcatheter heart valves (THVs) on the incidence of prosthesis–patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR). Background: PPM is a risk factor for accelerated degeneration of bioprosthetic aortic valves. Data on PPM after TAVR are derived mainly from studies of older generation THVs. Methods: PPM was assessed at 30 days post-TAVR with the older generation (Medtronic CoreValve, n = 120 and Edwards Sapien XT, n = 121) and the next generation THVs (Medtronic Evolut R/Pro, n = 136 and Edwards Sapien 3, n = 363). Results: The incidence of any and severe PPM was 15.1% and 0.0% for the older generation THVs, and 42.8% and 12.1% for the next generation THVs. The incidence of moderate and severe PPM was 23.3% and 3.5% in patients who received an Evolut R/Pro vs. 33.1% and 14.7% in those who received a Sapien 3 (P < 0.001). On multivariable analysis, TAVR with the Sapien 3 THV was not associated with PPM, while left ventricular ejection fraction (0.97 [0.95–0.99], P = 0.002), history of myocardial infarction (2.09 [1.00–4.34], P = 0.049), annulus maximum diameter (0.84 [0.77–0.92], P < 0.001), and THV oversizing (0.90 [0.87–0.94], P < 0.001) were independently associated with PPM. In Sapien 3, the risk of any and severe PPM was higher in those with no oversizing (odds ratio: 3.25 [1.23–8.53], P = 0.017 and 5.79[2.33–14.36], P < 0.001). Conclusions: The incidence of PPM in contemporary TAVR is significant, especially with the next generation BE THV without adequate oversizing.

OriginalspracheEnglisch
ZeitschriftCatheterization and Cardiovascular Interventions
Jahrgang93
Ausgabenummer5
Seiten (von - bis)971-979
Seitenumfang9
ISSN1522-1946
DOIs
PublikationsstatusVeröffentlicht - 01.04.2019

Fingerprint

Untersuchen Sie die Forschungsthemen von „Impact of prosthesis-iteration evolution and sizing practice on the incidence of prosthesis–patient mismatch after transcatheter aortic valve replacement“. Zusammen bilden sie einen einzigartigen Fingerprint.

Zitieren