Howard C Herrmann1, Samuel A Daneshvar2, Gregg C Fonarow2, Amanda Stebbins3, Sreekanth Vemulapalli3, Nimesh D Desai4, David J Malenka5, Vinod H Thourani6, Jennifer Rymer3, Andrzej S Kosinski3. 1. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: Howard.herrmann@uphs.upenn.edu. 2. University of California Los Angeles, Los Angeles, California. 3. Duke Clinical Research Institute, Durham North Carolina. 4. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. 5. Dartmouth-Hitchcock, Lebanon, New Hampshire. 6. MedStar Heart and Vascular Institute and Georgetown University, Washington, DC.
Abstract
BACKGROUND: Prosthesis-patient mismatch (PPM) after surgical aortic valve replacement (AVR) for aortic stenosis is generally associated with worse outcomes. Transcatheter AVR (TAVR) can achieve a larger valve orifice and the effects of PPM after TAVR are less well studied. OBJECTIVES: The authors utilized the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) registry to examine the frequency, predictors, and association with outcomes of PPM after TAVR in 62,125 patients enrolled between 2014 and 2017. METHODS: On the basis of the discharge echocardiographic effective valve area indexed to body surface area, PPM was classified as severe (<0.65 cm2/m2), moderate (0.65 to 0.85 cm2/m2), or none (>0.85 cm2/m2). Multivariable regression models were utilized to examine predictors of severe PPM as well as adjusted outcomes, including mortality, heart failure (HF) rehospitalization, stroke, and quality of life, at 1 year in 37,470 Medicare patients with claims linkage. RESULTS: Severe and moderate PPM were present following TAVR in 12% and 25% of patients, respectively. Predictors of severe PPM included small (≤23-mm diameter) valve prosthesis, valve-in-valve procedure, larger body surface area, female sex, younger age, non-white/Hispanic race, lower ejection fraction, atrial fibrillation, and severe mitral or tricuspid regurgitation. At 1 year, mortality was 17.2%, 15.6%, and 15.9% in severe, moderate, and no PPM patients, respectively (p = 0.02). HF rehospitalization had occurred in 14.7%, 12.8%, and 11.9% of patients with severe, moderate, and no PPM, respectively (p < 0.0001). There was no association of severe PPM with stroke or quality-of-life score at 1 year. CONCLUSIONS: Severe PPM after TAVR was present in 12% of patients and was associated with higher mortality and HF rehospitalization at 1 year. Further investigation is warranted into the prevention of severe PPM in patients undergoing TAVR.
BACKGROUND: Prosthesis-patient mismatch (PPM) after surgical aortic valve replacement (AVR) for aortic stenosis is generally associated with worse outcomes. Transcatheter AVR (TAVR) can achieve a larger valve orifice and the effects of PPM after TAVR are less well studied. OBJECTIVES: The authors utilized the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) registry to examine the frequency, predictors, and association with outcomes of PPM after TAVR in 62,125 patients enrolled between 2014 and 2017. METHODS: On the basis of the discharge echocardiographic effective valve area indexed to body surface area, PPM was classified as severe (<0.65 cm2/m2), moderate (0.65 to 0.85 cm2/m2), or none (>0.85 cm2/m2). Multivariable regression models were utilized to examine predictors of severe PPM as well as adjusted outcomes, including mortality, heart failure (HF) rehospitalization, stroke, and quality of life, at 1 year in 37,470 Medicare patients with claims linkage. RESULTS: Severe and moderate PPM were present following TAVR in 12% and 25% of patients, respectively. Predictors of severe PPM included small (≤23-mm diameter) valve prosthesis, valve-in-valve procedure, larger body surface area, female sex, younger age, non-white/Hispanic race, lower ejection fraction, atrial fibrillation, and severe mitral or tricuspid regurgitation. At 1 year, mortality was 17.2%, 15.6%, and 15.9% in severe, moderate, and no PPM patients, respectively (p = 0.02). HF rehospitalization had occurred in 14.7%, 12.8%, and 11.9% of patients with severe, moderate, and no PPM, respectively (p < 0.0001). There was no association of severe PPM with stroke or quality-of-life score at 1 year. CONCLUSIONS: Severe PPM after TAVR was present in 12% of patients and was associated with higher mortality and HF rehospitalization at 1 year. Further investigation is warranted into the prevention of severe PPM in patients undergoing TAVR.
Authors: Jaffar M Khan; Adam B Greenbaum; Vasilis C Babaliaros; Toby Rogers; Marvin H Eng; Gaetano Paone; Bradley G Leshnower; Mark Reisman; Lowell Satler; Ron Waksman; Marcus Y Chen; Annette M Stine; Xin Tian; Danny Dvir; Robert J Lederman Journal: JACC Cardiovasc Interv Date: 2019-06-12 Impact factor: 11.195
Authors: Matti Adam; Victor Mauri; Sarah Schmidt; Vera Fortmeier; Sebastian Ludwig; Hendrik Wienemann; Maria Isabel Körber; Samuel Lee; Max Meertens; Sascha Macherey; Christos Iliadis; Elmar Kuhn; Kaveh Eghbalzadeh; Sabine Bleiziffer; Stephan Baldus; Niklas Schofer; Tanja Katharina Rudolph Journal: Clin Res Cardiol Date: 2022-06-15 Impact factor: 5.460
Authors: Ole de Backer; Tobias Zeus; Verena Veulemans; Philippe Nuyens; Shouheng Goh; Oliver Maier; Stephan Binnebößel; Jacqueline Heermann; Christian Jung; Ralf Westenfeld; Malte Kelm Journal: Clin Res Cardiol Date: 2022-06-29 Impact factor: 5.460
Authors: Davut Cekmecelioglu; Ourania Preventza; Kathryn G Dougherty; Subhasis Chatterjee; Susan Y Green; Guilherme V Silva; Jose G Díez; Joseph S Coselli Journal: Ann Cardiothorac Surg Date: 2021-09
Authors: Pier Pasquale Leone; Fabio Fazzari; Francesco Cannata; Jorge Sanz-Sanchez; Antonio Mangieri; Lorenzo Monti; Ottavia Cozzi; Giulio Giuseppe Stefanini; Renato Bragato; Antonio Colombo; Bernhard Reimers; Damiano Regazzoli Journal: Front Cardiovasc Med Date: 2021-06-04