Frontiers in Cardiovascular Medicine (Jul 2022)

Prosthesis-patient mismatch following transcatheter aortic valve replacement for degenerated transcatheter aortic valves: the TRANSIT-PPM international project

  • Luca Testa,
  • Matteo Casenghi,
  • Enrico Criscione,
  • Nicolas M. Van Mieghem,
  • Didier Tchétché,
  • Anita W. Asgar,
  • Ole De Backer,
  • Azeem Latib,
  • Bernhard Reimers,
  • Giulio Stefanini,
  • Giulio Stefanini,
  • Carlo Trani,
  • Francesco Giannini,
  • Antonio Bartorelli,
  • Antonio Bartorelli,
  • Wojtek Wojakowski,
  • Maciej Dabrowski,
  • Dariusz Jagielak,
  • Adrian P. Banning,
  • Rajesh Kharbanda,
  • Raul Moreno,
  • Joachim Schofer,
  • Christina Brinkmann,
  • Niels van Royen,
  • Duane Pinto,
  • Antoni Serra,
  • Amit Segev,
  • Arturo Giordano,
  • Nedy Brambilla,
  • Mauro Agnifili,
  • Antonio Popolo Rubbio,
  • Mattia Squillace,
  • Jacopo Oreglia,
  • Rudolph Tanja,
  • James M. McCabe,
  • Alexander Abizaid,
  • Michiel Voskuil,
  • Rui Teles,
  • Giuseppe Biondi Zoccai,
  • Giuseppe Biondi Zoccai,
  • Lars Sondergaard,
  • Francesco Bedogni

DOI
https://doi.org/10.3389/fcvm.2022.931207
Journal volume & issue
Vol. 9

Abstract

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BackgroundA severe prosthesis-patient mismatch (PPM) is associated with adverse outcomes following transcatheter aortic valve replacement (TAVR) for de novo aortic stenosis or a failed surgical bioprosthesis. The impact of severe PPM in patients undergoing TAV-in-TAVR is unknown.AimWe sought to investigate the incidence and 1-year outcomes of different grades of PPM in patients undergoing TAV-in-TAVR.Materials and methodsThe TRANSIT-PPM is an international registry, including cases of degenerated TAVR treated with a second TAVR. PPM severity, as well as in-hospital, 30-day, and 1-year outcomes were defined according to the Valve Academic Research Consortium-3 (VARC-3) criteria.ResultsAmong 28 centers, 155 patients were included. Severe PPM was found in 6.5% of patients, whereas moderate PPM was found in 14.2% of patients. The rate of severe PPM was higher in patients who underwent TAV-in-TAVR with a second supra-annular self-expanding (S-SE) TAVR (10%, p = 0.04). Specifically, the rate of severe PPM was significantly higher among cases of a SE TAVR implanted into a balloon-expandable (BE) device (19%, p = 0.003). At 1-year follow-up, the rate of all-cause mortality, and the rate of patients in the New York Heart Association (NYHA) class III/IV were significantly higher in the cohort of patients with severe PPM (p = 0.016 and p = 0.0001, respectively). Almost all the patients with a severe PPM after the first TAVR had a failed < 23 mm BE transcatheter heart valve (THV): the treatment with an S-SE resolved the severe PPM in the majority of the cases.ConclusionAfter TAV-in-TAVR, in a fifth of the cases, a moderate or severe PPM occurred. A severe PPM is associated with an increased 1-year all-cause mortality.Clinical trial registration[https://clinicaltrials.gov], identifier [NCT04500964].

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