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Longitudinal Change in Galectin-3 and Incident Cardiovascular Outcomes Third-Generation Balloon and Self-Expandable Valves for Aortic Stenosis in Large and Extra-Large Aortic Annuli From the TAVR-LARGE Registry Impact of Intravascular Ultrasound-Guided Drug-Eluting Stent Implantation on Patients With Chronic Kidney Disease: Subgroup Analysis From ULTIMATE Trial Novel predictors of late lumen enlargement in distal reference segments after successful recanalization of coronary chronic total occlusion Lifestyle Modifications for Preventing and Treating Heart Failure Dual-antiplatelet treatment beyond 1 year after drug-eluting stent implantation (ARCTIC-Interruption): a randomised trial Effects of Intravascular Ultrasound-Guided Versus Angiography-Guided New-Generation Drug-Eluting Stent Implantation: Meta-Analysis With Individual Patient-Level Data From 2,345 Randomized Patients Noninvasive Nuclear SPECT Myocardial Blood Flow Quantitation to Guide Management for Coronary Artery Disease Impact of Lesion Preparation Strategies on Outcomes of Left Main PCI: The EXCEL Trial Chimney technique in a TAVR-in-TAVR procedure with high risk of left main artery ostium occlusion

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.