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Prognostic Value of the Residual SYNTAX Score After Functionally Complete Revascularization in ACS Optimal Timing of Intervention in NSTE-ACS Without Pre-Treatment The EARLY Randomized Trial Incidence and Outcomes of Acute Coronary Syndrome After Transcatheter Aortic Valve Replacement Right ventricular stroke work correlates with outcomes in pediatric pulmonary arterial hypertension Interval From Initiation of Prasugrel to Coronary Angiography in Patients With Non–ST-Segment Elevation Myocardial Infarction Optimal medical therapy vs. coronary revascularization for patients presenting with chronic total occlusion: A meta-analysis of randomized controlled trials and propensity score adjusted studies Radial versus femoral access and bivalirudin versus unfractionated heparin in invasively managed patients with acute coronary syndrome (MATRIX): final 1-year results of a multicentre, randomised controlled trial Effect of Pre-Hospital Crushed Prasugrel Tablets in Patients with STEMI Planned for Primary Percutaneous Coronary Intervention: The Randomized COMPARE CRUSH Trial Comparison in prevalence, predictors, and clinical outcome of VSR versus FWR after acute myocardial infarction: The prospective, multicenter registry MOODY trial-heart rupture analysis Fractional flow reserve vs. angiography in guiding management to optimize outcomes in non-ST-segment elevation myocardial infarction: the British Heart Foundation FAMOUS-NSTEMI randomized trial
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Original Research2020 Jul 5;S0167-5273(20)33411-2.

JOURNAL：Int J Cardiol . Article Link

Long-term outcome of prosthesis-patient mismatch after transcatheter aortic valve replacement

M Compagnone, G Marchetti, F Saia et al. Keywords: aortic valve stenosis; degenerated aortic valve bioprosthesis; prosthesis-patient mismatch; TAVR

ABSTRACT

BACKGROUND - Incidence and long-term clinical consequences of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) are still unclear.


METHODS - We enrolled 710 consecutive patients who underwent TAVR. PPM was defined as absent if the index orifice area (iEOA) was >0.85 cm2/m2, moderate if the iEOA was between 0.65 and 0.85 cm2/m2 or severe if the iEOA was <0.65 cm2/m2.

RESULTS - Among the 566 patients fulfilling the study criteria, the distribution of PPM was as follows: 50.5% none ( n = 286), 43% moderate PPM ( n = 243) and 6.5% severe PPM ( n = 37). At 5-year follow-up, patients with severe PPM had a significantly higher incidence of the combined endpoint of cardiovascular death, acute myocardial infarction and stroke ( p = .025) compared with the other patients. After adjusting the results for possible confounders, severe PPM remained an independent predictor of long-term adverse outcome (HR: 2.46; 95% Confidence Interval: 1.10–5.53). The independent predictors of severe PPM were valve-in-valve procedure and body mass index. Balloon-expandable valves were not associated with higher rates of severe PPM in comparison with self-expandable valves (5% vs. 8%, respectively, p = .245).


CONCLUSIONS -In our study severe PPM emerged as a risk factor for long-term major adverse cardiac and cerebrovascular events.
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