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

Abdelghani, Mohammad; Allali, Abdelhakim; Kaur, Jatinderjit; Hemetsberger, Rayyan; Mehilli, Julinda; Neumann, Franz-Josef; Frerker, Christian; Kurz, Thomas; El-Mawardy, Mohamed; Richardt, Gert und Abdel-Wahab, Mohamed (2019): Impact of prosthesis-iteration evolution and sizing practice on the incidence of prosthesis-patient mismatch after transcatheter aortic valve replacement. In: Catheterization and Cardiovascular Interventions, Bd. 93, Nr. 5: S. 971-979

Abstract

ObjectivesTo 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). BackgroundPPM 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. MethodsPPM was assessed at 30days 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). ResultsThe 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). ConclusionsThe incidence of PPM in contemporary TAVR is significant, especially with the next generation BE THV without adequate oversizing.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 1522-1946
• Sprache: Englisch