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Bacigalupi E, Perfetti M, Zimarino M. Prosthesis-patient mismatch prediction in TAVR valve-in-valve procedures. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00609-2. [PMID: 39089910 DOI: 10.1016/j.carrev.2024.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024]
Affiliation(s)
- Elena Bacigalupi
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Matteo Perfetti
- Cardiology Department, SS. Annunziata Hospital, ASL 2 Abruzzo, Chieti, Italy
| | - Marco Zimarino
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy; Cardiology Department, SS. Annunziata Hospital, ASL 2 Abruzzo, Chieti, Italy.
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Ellfors E, Dismorr M, Rück A, Settergren M, Sartipy U, Glaser N. Predicted prosthesis-patient mismatch and long-term clinical outcomes after transcatheter aortic valve replacement: A SWEDEHEART study. Am Heart J 2024; 276:70-82. [PMID: 39032585 DOI: 10.1016/j.ahj.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/07/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND The impact of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) is uncertain. This study was performed to investigate the risk of all-cause mortality, heart failure hospitalization, and aortic valve reintervention in patients with and without predicted PPM after TAVR. METHODS This nationwide, population-based cohort study included all patients who underwent transfemoral primary TAVR in Sweden from 2008 to 2022 in the SWEDEHEART register. PPM was defined according to published effective orifice areas for each valve model and size. The patients were divided into those with and without PPM. Additional baseline characteristics and outcome data were obtained from other national health data registers. Regression standardization was used to adjust for intergroup differences. RESULTS Of 8485 patients, 7879 (93%) had no PPM and 606 (7%) had PPM. The crude cumulative incidence of all-cause mortality at 1, 5, and 10 years in patients with versus without PPM was 7% versus 9%, 40% versus 44%, and 80% versus 85%, respectively. After regression standardization, there was no between-group difference in long-term mortality, and the absolute difference at 10 years was 1.5% (95% confidence interval, -2.9%-6.0%). The mean follow-up was 3.0 years (maximum, 14 years). There was no difference in the risk of heart failure hospitalization or aortic valve reintervention. CONCLUSIONS The risk of all-cause mortality, heart failure hospitalization, or aortic valve reintervention was not higher in patients with than without predicted PPM following TAVR. Furthermore, PPM was present in only 7% of patients, and severe PPM was almost nonexistent.
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Affiliation(s)
- Emma Ellfors
- Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - Michael Dismorr
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Rück
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Settergren
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ulrik Sartipy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Natalie Glaser
- Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Sugiyama Y, Miyashita H, Ochiai T, Shishido K, Jalanko M, Yamanaka F, Vähäsilta T, Saito S, Laine M, Moriyama N. Haemodynamic and clinical outcomes at 5 years according to predicted prosthesis-patient mismatch after transcatheter aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00541-4. [PMID: 38944598 DOI: 10.1016/j.carrev.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 06/11/2024] [Accepted: 06/11/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND/PURPOSE Although the impact of predicted prosthesis-patient mismatch (PPMP) on outcomes after surgical aortic valve replacement is well established, studies on PPMP in transcatheter aortic valve replacement (TAVR) are limited. This study investigated the effects of PPMp on haemodynamic and 5-year clinical outcomes after TAVR. METHODS/MATERIALS We analysed 1733 patients who underwent TAVR. PPMp was defined using two different methods: 1) normal reference values of the effective orifice area for each valve type and size indexed to body surface area (PPMp1; n = 1733) and 2) reference values for aortic annulus area or perimeter assessed with pre-procedural computed tomography indexed to body surface area (PPMp2; n = 1227). The primary endpoint was the composite of all-cause death and/or rehospitalisation for heart failure at 5 years. RESULTS The incidence of PPMp1 was 11.7 % and 0.8 % in moderate and severe cases, respectively. PPMp2 was classified as either moderate (3.8 %) or severe (0 %). Rates of residual mean aortic gradient ≥20 mmHg significantly increased depending on PPMp1 severity (no PPMp1: 3.1 % vs. moderate PPMp1: 26.8 % vs. severe PPMp1: 53.9 %, p < 0.0001) and PPMp2 (no PPMp2: 4.1 % vs. moderate PPMp2: 12.8 %, p = 0.0049). Neither of PPMP methods were associated with the composite outcome in total cohort; however, PPMP1 was significantly related to worse clinical outcomes at 5 years among patients with reduced left ventricular ejection fraction (LVEF) in multivariate analysis (HR: 1.87; 95 % CI: 1.02-3.43). CONCLUSIONS The impact of PPMP on TAVR clinical outcomes may not be negligible in patients with low LVEF.
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Affiliation(s)
- Yoichi Sugiyama
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa 247-8533, Japan; Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Hirokazu Miyashita
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa 247-8533, Japan
| | - Tomoki Ochiai
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa 247-8533, Japan
| | - Koki Shishido
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa 247-8533, Japan
| | - Mikko Jalanko
- Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Futoshi Yamanaka
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa 247-8533, Japan
| | - Tommi Vähäsilta
- Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Shigeru Saito
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa 247-8533, Japan
| | - Mika Laine
- Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Noriaki Moriyama
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa 247-8533, Japan.
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4
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Leone PP, Sturla M, Spring AM, Echarte-Morales J, Scotti A, Ludwig S, Coisne A, Slipczuk L, Assafin M, Chau M, Ho EC, Granada JF, Latib A. Routine postdilation after 23 mm Sapien 3 Ultra implantation in the aortic position. Catheter Cardiovasc Interv 2024. [PMID: 38841916 DOI: 10.1002/ccd.31116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/14/2024] [Accepted: 05/26/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Residual transprosthetic gradient (TG) after transcatheter aortic valve replacement (TAVR) with balloon-expandable valves (BEV) may be due to suboptimal valve expansion. AIMS To compare hemodynamics after TAVR with small BEV according to postdilation strategy. METHODS This observational, retrospective cohort study included 184 consecutive patients from a single center treated with 23 mm Sapien 3 Ultra (Edwards Lifesciences) BEV implantation in the aortic position and enrolled between January 2020 and April 2023. Patients treated with routine postdilation (RP, n = 73) were compared to patients treated according to local standard practice (SP, n = 111). Primary endpoint was 30-day mean TG. Secondary endpoints were incidence of 30-day prosthesis-patient mismatch (PPM), technical success and device success. RESULTS Thirty-day mean TG was lower in RP versus SP (12.3 ± 4.6 mmHg vs. 14.1 ± 5.7 mmHg, p = 0.031), and incidence of PPM was less common with RP versus SP (47.3% vs. 71.0%, p = 0.006). Technical success (98.6% vs. 99.1%, p = 0.637) and device success (93.1% vs. 90.1%, p = 0.330) did not differ between groups. Differences in 30-day mean TG were driven by patients at normal flow (12.1 ± 4.0 mmHg vs. 15.0 ± 5.5 mmHg, p = 0.014), while no differences were evident among patients at low flow (12.5 ± 5.5 mmHg vs. 11.7 ± 5.5 mmHg, p = 0.644). RP decreased height and increased width of BEV, and a linear regression established that final BEV width could predict 30-day mean TG (r = -0.6654, p < 0.0001). CONCLUSIONS RP after TAVR with small BEV was associated with more favorable forward-flow hemodynamics than SP.
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Affiliation(s)
- Pier Pasquale Leone
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Matteo Sturla
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | | | | | - Andrea Scotti
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
- Cardiovascular Research Foundation, New York, USA
| | - Sebastian Ludwig
- Cardiovascular Research Foundation, New York, USA
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Augustin Coisne
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
- Cardiovascular Research Foundation, New York, USA
- Inserm, CHU Lille, Institut Pasteur de Lille, University of Lille, Lille, France
| | - Leandro Slipczuk
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Manaf Assafin
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Mei Chau
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Edwin C Ho
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Juan F Granada
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
- Cardiovascular Research Foundation, New York, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
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Bruno F, Rampone JM, Islas F, Gorla R, Gallone G, Melillo F, Leone PP, Cimaglia P, Pastore MC, Franzone A, Landra F, Scudeler L, Jimenez-Quevedo P, Viva T, Piroli F, Bragato R, Trichilo M, Degiovanni A, Salizzoni S, Ilardi F, Andreis A, Nombela-Franco L, Tusa M, Toselli M, Conrotto F, Montorfano M, Manzo R, Cameli M, Patti G, Stefanini G, Testa L, La Torre M, Giannini F, Agricola E, Escaned J, De Filippo O, De Ferrari GM, D'Ascenzo F. Echocardiographic and clinical features of patients developing prosthesis-patient mismatch after transcatheter aortic valve replacement: Insights from the Recovery-TAVR registry. Am Heart J 2024; 275:128-137. [PMID: 38838970 DOI: 10.1016/j.ahj.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 05/26/2024] [Accepted: 05/27/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The impact of prosthesis-patient mismatch (PPM) on major endpoints after transcatheter aortic valve replacement (TAVR) is controversial and the effects on progression of heart damage are poorly investigated. Therefore, our study aims to evaluate the prevalence and predictors of PPM in a "real world" cohort of patients at intermediate and low surgical risk, its impact on mortality and the clinical-echocardiographic progression of heart damage. METHODS 963 patients who underwent TAVR procedure between 2017 and 2021, from the RECOVERY-TAVR international multicenter observational registry, were included in this analysis. Multiparametric echocardiographic data of these patients were analyzed at 1-year follow-up (FU). Clinical and echocardiographic features were stratified by presence of PPM and PPM severity, as per the most current international recommendations, using VARC-3 criteria. RESULTS 18% of patients developed post-TAVR. PPM, and 7.7% of the whole cohort had severe PPM. At baseline, 50.3% of patients with PPM were male (vs 46.2% in the cohort without PPM, P = .33), aged 82 (IQR 79-85y) years vs 82 (IQR 78-86 P = .46), and 55.6% had Balloon-Expandable valves implanted (vs 46.8% of patients without PPM, P = .04); they had smaller left ventricular outflow tract (LVOT) diameter (20 mm, IQR 19-21 vs 20 mm, IQR 20-22, P = .02), reduced SVi (34.2 vs 38 mL/m2, P < .01) and transaortic flow rate (190.6 vs 211 mL/s, P < .01). At predischarge FU patients with PPM had more paravalvular aortic regurgitation (moderate-severe AR 15.8% vs 9.2%, P < .01). At 1-year FU, maladaptive alterations of left ventricular parameters were found in patients with PPM, with a significant increase in end-systolic diameter (33 mm vs 28 mm, P = .03) and a significant increase in left ventricle end systolic indexed volume in those with moderate and severe PPM (52 IQR 42-64 and 52, IQR 41-64 vs 44 IQR 35-59 in those without, P = .02)). No evidence of a significant impact of PPM on overall (P = .71) and CV (P = .70) mortality was observed. Patients with moderate/severe PPM had worse NYHA functional class at 1 year (NYHA III-IV 13% vs 7.8%, P = .03). Prosthesis size≤23 mm (OR 11.6, 1.68-80.1) was an independent predictor of PPM, while SVi (OR 0.87, 0.83-0.91, P < .001) and LVOT diameter (OR 0.79, 0.65-0.95, P = .01) had protective effect. CONCLUSIONS PPM was observed in 18% of patients undergoing TAVR. Echocardiographic evaluations demonstrated a PPM-related pattern of early ventricular maladaptive alterations, possibly precursor to a reduction in cardiac function, associated with a significant deterioration in NYHA class at 1 year. These findings emphasize the importance of prevention of PPM of any grade in patients undergoing TAVR procedure, especially in populations at risk.
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Affiliation(s)
- Francesco Bruno
- Department of Medical Sciences, Division of Cardiology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Joao Matteo Rampone
- Department of Medical Sciences, Division of Cardiology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Fabian Islas
- Department of Cardiology, Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Riccardo Gorla
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Guglielmo Gallone
- Department of Medical Sciences, Division of Cardiology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Pier Pasquale Leone
- Department of Cardiology, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Paolo Cimaglia
- Department of Cardiology, GVM Care and Research, Maria Cecilia Hospital, Ravenna, Italy
| | - Maria Concetta Pastore
- Department of Cardiology, Azienda Ospedaliero Universitaria "Maggiore Della Carita", Novara, Italy
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Federico Landra
- Department of Cardiovascular Diseases, University of Siena, Policlinico "Le Scotte", Viale Bracci 1, 53100 Siena, Italy
| | - Luca Scudeler
- Department of Medical Sciences, Division of Cardiology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Pilar Jimenez-Quevedo
- Department of Cardiology, Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Tommaso Viva
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Francesco Piroli
- Department of Cardiology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Renato Bragato
- Department of Cardiology, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Michele Trichilo
- Department of Cardiology, GVM Care and Research, Maria Cecilia Hospital, Ravenna, Italy
| | - Anna Degiovanni
- Department of Cardiology, Azienda Ospedaliero Universitaria "Maggiore Della Carita", Novara, Italy
| | - Stefano Salizzoni
- Cardiovascular and Thoracic Department, Division of Cardiac Surgery, Città Della Salute e Della Scienza Hospital and University of Turin, Turin, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Alessandro Andreis
- Department of Medical Sciences, Division of Cardiology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Luis Nombela-Franco
- Department of Cardiology, Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Maurizio Tusa
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Marco Toselli
- Department of Cardiology, GVM Care and Research, Maria Cecilia Hospital, Ravenna, Italy
| | - Federico Conrotto
- Department of Medical Sciences, Division of Cardiology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Rachele Manzo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Policlinico "Le Scotte", Viale Bracci 1, 53100 Siena, Italy
| | - Giuseppe Patti
- Department of Cardiology, Azienda Ospedaliero Universitaria "Maggiore Della Carita", Novara, Italy
| | - Giulio Stefanini
- Department of Cardiology, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Luca Testa
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Michele La Torre
- Cardiovascular and Thoracic Department, Division of Cardiac Surgery, Città Della Salute e Della Scienza Hospital and University of Turin, Turin, Italy
| | - Francesco Giannini
- Department of Cardiology, GVM Care and Research, Maria Cecilia Hospital, Ravenna, Italy
| | | | - Javier Escaned
- Department of Cardiology, Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Ovidio De Filippo
- Department of Medical Sciences, Division of Cardiology, Città della Salute e della Scienza, University of Turin, Turin, Italy.
| | - Gaetano M De Ferrari
- Department of Medical Sciences, Division of Cardiology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Fabrizio D'Ascenzo
- Department of Medical Sciences, Division of Cardiology, Città della Salute e della Scienza, University of Turin, Turin, Italy
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Sá MP, Jacquemyn X, Van den Eynde J, Chu D, Serna‐Gallegos D, Ebels T, Clavel M, Pibarot P, Sultan I. Impact of Prosthesis-Patient Mismatch After Surgical Aortic Valve Replacement: Systematic Review and Meta-Analysis of Reconstructed Time-to-Event Data of 122 989 Patients With 592 952 Patient-Years. J Am Heart Assoc 2024; 13:e033176. [PMID: 38533939 PMCID: PMC11179750 DOI: 10.1161/jaha.123.033176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/28/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND It remains controversial whether prosthesis-patient mismatch (PPM) impacts long-term outcomes after surgical aortic valve replacement. We aimed to evaluate the association of PPM with mortality, rehospitalizations, and aortic valve reinterventions. METHODS AND RESULTS We performed a systematic review with meta-analysis of reconstructed time-to-event data of studies published by March 2023 (according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Sixty-five studies met our eligibility criteria and included 122 989 patients (any PPM: 68 332 patients, 55.6%). At 25 years of follow-up, the survival rates were 11.8% and 20.6% in patients with and without any PPM, respectively (hazard ratio [HR], 1.16 [95% CI, 1.13-1.18], P<0.001). At 20 years of follow-up, the survival rates were 19.5%, 12.1%, and 8.8% in patients with no, moderate, and severe PPM, respectively (moderate versus no PPM: HR, 1.09 [95% CI, 1.06-1.11], P<0.001; severe versus no PPM: HR, 1.29 [95% CI, 1.24-1.35], P<0.001). PPM was associated with higher risk of cardiac death, heart failure-related hospitalizations, and aortic valve reinterventions over time (P<0.001). Statistically significant associations between PPM and worse survival were observed regardless of valve type (bioprosthetic versus mechanical valves), contemporary PPM definitions unadjusted and adjusted for body mass index, and PPM quantification method (in vitro, in vivo, Doppler echocardiography). Our meta-regression analysis revealed that populations with more women tend to have higher HRs for all-cause death associated with PPM. CONCLUSIONS The results of the present study suggest that any degree of PPM is associated with poorer long-term outcomes following surgical aortic valve replacement and provide support for implementation of preventive strategies to avoid PPM after surgical aortic valve replacement.
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Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiothoracic SurgeryUniversity of PittsburghPAUSA
- University of Pittsburgh Medical CenterUPMC Heart and Vascular InstitutePittsburghPAUSA
| | | | | | - Danny Chu
- Department of Cardiothoracic SurgeryUniversity of PittsburghPAUSA
- University of Pittsburgh Medical CenterUPMC Heart and Vascular InstitutePittsburghPAUSA
| | - Derek Serna‐Gallegos
- Department of Cardiothoracic SurgeryUniversity of PittsburghPAUSA
- University of Pittsburgh Medical CenterUPMC Heart and Vascular InstitutePittsburghPAUSA
| | - Tjark Ebels
- Department of Cardiothoracic Surgery, University Medical Center GroningenUniversity of GroningenThe Netherlands
| | - Marie‐Annick Clavel
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de QuébecQuébec CityQuébecCanada
- Department of Medicine, Faculty of MedicineUniversité LavalQuébec CityQuébecCanada
| | - Philippe Pibarot
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de QuébecQuébec CityQuébecCanada
- Department of Medicine, Faculty of MedicineUniversité LavalQuébec CityQuébecCanada
| | - Ibrahim Sultan
- Department of Cardiothoracic SurgeryUniversity of PittsburghPAUSA
- University of Pittsburgh Medical CenterUPMC Heart and Vascular InstitutePittsburghPAUSA
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7
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Peters AC, Gong FF, Ramesh A, Andrei A, Jankowski M, Cantey E, Chen V, Thomas JD, Flaherty JD, Malaisrie SC, Maganti K. Echocardiographic parameters associated with less reverse left ventricular remodeling after transcatheter aortic valve implant in subjects with prosthesis patient mismatch. Echocardiography 2024; 41:e15698. [PMID: 38284664 DOI: 10.1111/echo.15698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/15/2023] [Accepted: 09/16/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Transaortic valve implant (TAVI) is the treatment of choice for severe aortic stenosis (AS). Some patients develop prosthesis patient mismatch (PPM) after TAVI. It is challenging to determine which patients are at risk for clinical deterioration. METHODS We retrospectively measured echocardiographic parameters of left ventricular (LV) morphology and function, prosthetic aortic valve effective orifice area (iEOA) and hemodynamics in 313 patients before and 1 year after TAVI. Our objective was to compare the change in echocardiographic parameters associated with left ventricular reverse modeling in subjects with and without PPM. Our secondary objective was to evaluate echo parameters associated with PPM and the relationship to patient functional status and survival post-TAVI. RESULTS We found that 82 (26.2%) of subjects had moderate and 37 (11.8%) had severe PPM post-TAVI. There was less relative improvement in LVEF with PPM (1.9 ± 21.3% vs. 8.2 + 30.1%, p = .045). LV GLS also exhibited less relative improvement in those with PPM (13.4 + 34.1% vs. 30.9 + 73.3%, p = .012). NYHA functional class improved in 84.3% of subjects by one grade or more. Echocardiographic markers of PPM were worse in those without improvement in NYHA class (mean AT/ET was .29 vs. .27, p = .05; DVI was .46 vs. .51, p = .021; and iEOA was .8 cm/m2 vs. .9 cm/m2 , p = .025). There was no association with PPM and survival. CONCLUSIONS There was no improvement in LVEF and less improvement in LV GLS in those with PPM post-TAVI. Echocardiographic markers of PPM were present in those with lack of improvement in NYHA functional class.
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Affiliation(s)
- Andrew C Peters
- Northwestern University Feinberg School of Medicine, Chicago, USA
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Fei Fei Gong
- Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Ashvita Ramesh
- Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Adin Andrei
- Northwestern University Feinberg School of Medicine, Chicago, USA
| | | | - Eric Cantey
- Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Vincent Chen
- Northwestern University Feinberg School of Medicine, Chicago, USA
| | - James D Thomas
- Northwestern University Feinberg School of Medicine, Chicago, USA
| | - James D Flaherty
- Northwestern University Feinberg School of Medicine, Chicago, USA
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Levesque T, Eltchaninoff H, Chabannes R, Barbe T, Dosseh O, Tron C, Bettinger N, Bouhzam N, Hemery T, le Pessec G, Fauvel C, Cribier A, Pibarot P, Durand E. Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement. Can J Cardiol 2024; 40:113-122. [PMID: 37726077 DOI: 10.1016/j.cjca.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/31/2023] [Accepted: 09/09/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Data on the long-term impact of prosthesis-patient mismatch (PPM) on outcomes after transcatheter aortic valve replacement (TAVR) remain sparse. We therefore aimed to investigate the incidence, predictive factors, and long-term prognostic impact of PPM on bioprosthesis durability and mortality. METHODS This was a single-centre retrospective study including 2117 patients who underwent TAVR for aortic stenosis from 2002 to 2022. Moderate PPM was defined by indexed effective orifice area (iEOA) > 0.65 and ≤ 0.85 cm2/m2 (> 0.55 and ≤ 0.70 cm2/m2 if BMI ≥ 30 kg/m2) and severe PPM by an iEOA ≤ 0.65 cm2/m2 (≤ 0.55 cm2/m2 If BMI ≥ 30 kg/m2). RESULTS There were 351 patients (16.6%) with PPM, including 39 patients (1.8%) with severe PPM and 312 patients (14.7%) with moderate PPM. The mean follow-up duration was 31.2 ± 26.5 months. Factors independently associated with the occurrence of PPM were body surface area (odds ratio [OR] 3.32, 95% confidence interval [CI] 1.32-8.35; P = 0.01), valve-in-valve TAVR (OR 6.12, 95% CI 2.29-16.08; P < 0.001), small annulus (OR 2.42, 95% CI 1.41-4.07; P = 0.001), and the use of a balloon-expandable valve (OR 4.17, 95% CI 2.17-8.33; P < 0.001). PPM was associated with increased risk of mortality (hazard ratio [HR] 1.3, 95% CI 1.1-1.5, P = 0.004) and valve thrombosis (HR 4.2, 95% CI 1.4-12.6, P = 0.01), and a trend towards increased risk of structural valve deterioration (HR 1.7, 95% CI 0.9-2.9; P = 0.08). CONCLUSIONS The results of this study suggest that PPM has a negative long-term impact on outcomes after TAVR. These findings emphasise the importance of preventing PPM.
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Affiliation(s)
- Thomas Levesque
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Hélène Eltchaninoff
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Romain Chabannes
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Thomas Barbe
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Olivier Dosseh
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Christophe Tron
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Nicolas Bettinger
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Najime Bouhzam
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Thibaut Hemery
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Guillaume le Pessec
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Charles Fauvel
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Alain Cribier
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Philippe Pibarot
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - Eric Durand
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France.
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9
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Gooley R, Murdoch D, Ng MK, Modolo R, Allocco DJ. First results from the ACURATE Prime XL human feasibility study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 57:1-5. [PMID: 37429793 DOI: 10.1016/j.carrev.2023.06.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/16/2023] [Accepted: 06/27/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND/PURPOSE This prospective, open-label, single-arm study evaluated transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis with ACURATE Prime XL, an iteration of the ACURATE neo2 device designed with improved radial force and adaptations for compatibility with a larger annulus diameter (≥ 26.5 mm and ≤ 29 mm based on pre-procedure diagnostic imaging). METHODS The composite primary device success endpoint was based on Valve Academic Research Consortium (VARC)-2 criteria. The primary safety endpoint was a composite of all-cause mortality and all stroke at 30 days. Aortic valve (AV) performance, including mean AV gradient, AV area, and grade of paravalvular leak (PVL), was assessed by an independent core laboratory. RESULTS 13 male patients were enrolled at 3 Australian centers (mean age: 83.1 years; 10 of 13 were considered high/extreme operative risk). 61.5 % of patients met the primary device success endpoint. At 30 days, no patients experienced death or stroke; one patient received a permanent pacemaker. Mean AV gradient improved from baseline (42.7 ± 11.0 mmHg) to discharge (7.7 ± 2.5 mmHg) and through 30 days (7.2 ± 2.3 mmHg). Mean AV area was 0.8 ± 0.1 cm2 at baseline, 1.9 ± 0.3 cm2 at discharge, and 1.7 ± 0.3 cm2 at 30 days. Per core-laboratory adjudication, no patient had moderate or severe PVL at 30 days; 91.7 % had no/trace PVL and 8.3 % had mild PVL. CONCLUSIONS AND RELEVANCE In this first-in-human feasibility study of the ACURATE Prime XL valve, there were no safety concerns, and no deaths or strokes within 30 days. Valve hemodynamics were favorable, and no patient had >mild PVL.
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Affiliation(s)
- Robert Gooley
- Monash Heart, Monash Health, Clayton, Victoria, Australia.
| | - Dale Murdoch
- The Prince Charles Hospital, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
| | - Martin K Ng
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
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10
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Leone PP, Regazzoli D, Pagnesi M, Costa G, Teles R, Adamo M, Taramasso M, De Marco F, Mangieri A, Kargoli F, Ohno Y, Saia F, Ielasi A, Ribichini F, Maffeo D, Kim WK, Maisano F, Van Mieghem NM, Colombo A, Reimers B, Latib A. Prosthesis-patient mismatch after transcatheter implantation of contemporary balloon-expandable and self-expandable valves in small aortic annuli. Catheter Cardiovasc Interv 2023; 102:931-943. [PMID: 37668097 DOI: 10.1002/ccd.30818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/29/2023] [Accepted: 08/19/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Evidence of clinical impact of PPM after TAVI is conflicting and might vary according to the type of valve implanted. AIMS To assess the clinical impact of prosthesis-patient mismatch (PPM) after transcatheter aortic valve implantation (TAVI) with balloon-expandable (BEV) and self-expandable valves (SEV) in patients with small annuli. METHODS TAVI-SMALL 2 enrolled 628 patients in an international retrospective registry, which included patients with severe aortic stenosis and small annuli (annular perimeter <72 mm or area <400 mm2 ) treated with transfemoral TAVI at 16 high-volume centers between 2011 and 2020. Analyses were performed comparing patients with less than moderate (n = 452), moderate (n = 138), and severe PPM (n = 38). Primary endpoint was incidence of all-cause mortality. Predictors of all-cause mortality and PPM were investigated. RESULTS At a median follow-up of 380 days (interquartile range: 210-709 days), patients with severe PPM, but not moderate PPM, had an increased risk of all-cause mortality when compared with less than moderate PPM (log-rank p = 0.046). Severe PPM predicted all-cause mortality in patients with BEV (hazard ratio [HR]: 5.20, 95% confidence interval [CI]: 1.27-21.2) and intra-annular valves (IAVs, HR: 4.23, 95% CI: 1.28-14.02), and it did so with borderline significance in the overall population (HR: 2.89, 95% CI: 0.95-8.79). Supra-annular valve (SAV) implantation was the only predictor of severe PPM (odds ratio: 0.33, 95% CI: 0.13-0.83). CONCLUSIONS Patients with small aortic annuli and severe PPM after TAVI have an increased risk of all-cause mortality at early term follow-up, especially after IAV or BEV implantation. TAVI with SAV protected from severe PPM.
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Affiliation(s)
- Pier Pasquale Leone
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Damiano Regazzoli
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Matteo Pagnesi
- Department of Medical and Surgical specialties, Radiological Sciences and Public Health, Institute of Cardiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Giuliano Costa
- U.O.C. Cardiologia, Centro Alte Specialità e Trapianti, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Rui Teles
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Nova Medical School, CEDOC, Lisbon, Portugal
| | - Marianna Adamo
- Department of Medical and Surgical specialties, Radiological Sciences and Public Health, Institute of Cardiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Maurizio Taramasso
- HerzZentrum Hirslanden Zurich, University of Zurich, Zurich, Switzerland
| | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Faraj Kargoli
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Yohei Ohno
- Department of Cardiology, Tokai University Hospital, Kanagawa, Japan
| | - Francesco Saia
- Cardiology Unit, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alfonso Ielasi
- Clinical and Interventional Unit, Sant'Ambrogio Cardio-Thoracic Center, Milan, Italy
| | - Flavio Ribichini
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Diego Maffeo
- Cardiovascular Department, Interventional Cardiology Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Francesco Maisano
- Cardio-Thoracic-Vascular Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Bernhard Reimers
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
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11
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Malvindi PG, Bifulco O, Berretta P, Alfonsi J, Cefarelli M, Zingaro C, Capestro F, D’Alfonso A, Di Eusanio M. Improved Early Outcomes in Women Undergoing Aortic Valve Interventions. J Clin Med 2023; 12:5749. [PMID: 37685816 PMCID: PMC10488507 DOI: 10.3390/jcm12175749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/24/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Surgical aortic valve replacement (SAVR) in female patients has been associated with higher mortality (up to 3.3-8.9%) and postoperative complication rates when compared with their male counterparts. In recent years, TAVI has been shown to provide a greater benefit than SAVR in women. We sought to assess the early outcomes of the contemporary aortic valve intervention practice (surgical and transcatheter) in patients referred to our cardiac surgery unit. The data of consecutive patients who underwent isolated aortic valve intervention for aortic valve stenosis during the 2018-2022 period were retrieved from our internal database. Several preoperative, intraoperative, and postoperative variables were analyzed, including the predicted risk of a prosthesis-patient mismatch. Nine hundred and fifty-five consecutive patients-514 women and 441 men-were included. Among them, 480 patients-276 female and 204 male-received a transcatheter procedure, and 475-238 women and 237 men-had conventional SAVR. The women were older and had higher EuroSCORE II, while the male patients presented a higher incidence of cardiovascular comorbidities. There was no difference in mortality or major postoperative complication rates after either the surgical or transcatheter procedures between the female and male populations. The availability and targeted use of different techniques and technologies have enabled the safe and effective treatment of female patients treated for severe symptomatic aortic valve stenosis with similar results when compared with their male counterparts.
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12
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Fazmin IT, Ali JM. Prosthesis-Patient Mismatch and Aortic Root Enlargement: Indications, Techniques and Outcomes. J Cardiovasc Dev Dis 2023; 10:373. [PMID: 37754802 PMCID: PMC10531615 DOI: 10.3390/jcdd10090373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023] Open
Abstract
Prosthesis-patient mismatch (PPM) is defined as implanting a prosthetic that is insufficiently sized for the patient receiving it. PPM leads to high residual transvalvular gradients post-aortic valve replacement and consequently results in left ventricular dysfunction, morbidity and mortality in both the short and long term. Younger patients and patients with poor preoperative left ventricular function are more vulnerable to increased mortality secondary to PPM. There is debate over the measurement of valvular effective orifice area (EOA) and variation exists in how manufacturers report the EOA. The most reliable technique is using in vivo echocardiographic measurements to create tables of predicted EOAs for different valve sizes. PPM can be prevented surgically in patients at risk through aortic root enlargement (ARE). Established techniques include the posterior enlargement through Nicks and Manouguian procedures, and aortico-ventriculoplasty with the Konno-Rastan procedure, which allows for a greater enlargement but carries increased surgical risk. A contemporary development is the Yang procedure, which uses a Y-shaped incision created through the non- and left-coronary cusp commissure, undermining the nadirs of the non- and left-coronary cusps. Early results are promising and demonstrate an ability to safely increase the aortic root by up to two to three sizes. Aortic root enlargement thus remains a valuable and safe tool in addressing PPM, and should be considered during surgical planning.
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13
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Bernard J, Georges G, Hecht S, Pibarot P, Clavel MA, Babaki S, Kalavrouziotis D, Mohammadi S. Mid-term clinical and echocardiographic results of the INSPIRIS RESILIA aortic valve: a retrospective comparison to the Magna Ease. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad117. [PMID: 37462610 PMCID: PMC10386877 DOI: 10.1093/icvts/ivad117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/12/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVES The INSPIRIS aortic valve combines the RESILIA proprietary tissue preservation process and an expandable stent frame to benefit future transcatheter valve-in-valve procedures. As the INSPIRIS valve became commercially available in 2017, mid-term outcome reports are scarce. We aimed to evaluate mid-term safety and echocardiographic performance of the INSPIRIS valve in comparison to its predecessor, the Carpentier Edwards Perimount Magna Ease (ME). METHODS This study was a retrospective single-centre study. Clinical results included early postoperative outcomes, mid-term mortality and readmission for cardiovascular cause or stroke. Echocardiographic follow-up (FU) was performed at discharge and 1-3, 6, 12 and 24 months. Clinical end point analyses were accomplished with a propensity score matching analysis and FU echocardiographic data comparisons using pairwise analyses and linear mixed-effect models. RESULTS We included 953 patients who received an INSPIRIS (n = 488) or ME (n = 463) bioprosthesis between January 2018 and July 2021. In the matched population (n = 217 per group), no significant difference in short-term outcomes was observed, survival was similar at 30 months (INSPIRIS: 94% vs ME: 91%, P = 0.89), but freedom from readmission was higher in the INSPIRIS group (94% vs 86%, P = 0.014). INSPIRIS valves had a lower gradient at discharge (∼10 vs 14 mmHg, P < 0.001), 1-3 months (∼10 vs 12 mmHg, P < 0.001) and 24 months (∼11 vs 17 mmHg, P < 0.001) in paired analyses and significantly lower evolution of mean transvalvular gradients compared to ME. CONCLUSIONS This study represents the largest comparative evaluation of the INSPIRIS to the ME valves, which demonstrated safe clinical outcomes and favourable haemodynamic performance at 2 years. Long-term FU is underway.
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Affiliation(s)
- Jérémy Bernard
- Cardiology Division, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval/Quebec Heart and Lung Institute - Laval University, Quebec, QC, Canada
| | - Gabriel Georges
- Cardiac Surgery Division, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval/Quebec Heart and Lung Institute - Laval University, Quebec, QC, Canada
| | - Sébastien Hecht
- Cardiology Division, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval/Quebec Heart and Lung Institute - Laval University, Quebec, QC, Canada
| | - Philippe Pibarot
- Cardiology Division, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval/Quebec Heart and Lung Institute - Laval University, Quebec, QC, Canada
| | - Marie-Annick Clavel
- Cardiology Division, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval/Quebec Heart and Lung Institute - Laval University, Quebec, QC, Canada
| | - Shervin Babaki
- Research Division, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval/Quebec Heart and Lung Institute - Laval University, Quebec, QC, Canada
| | - Dimitri Kalavrouziotis
- Cardiac Surgery Division, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval/Quebec Heart and Lung Institute - Laval University, Quebec, QC, Canada
| | - Siamak Mohammadi
- Cardiac Surgery Division, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval/Quebec Heart and Lung Institute - Laval University, Quebec, QC, Canada
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Comparison of Echocardiographic and Catheter Mean Gradient to Assess Stenosis After Transcatheter Aortic Valve Implantation. Am J Cardiol 2023; 191:110-118. [PMID: 36669380 DOI: 10.1016/j.amjcard.2022.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/15/2022] [Accepted: 12/26/2022] [Indexed: 01/20/2023]
Abstract
Discordance exists between Doppler-derived and left heart catheterization (LHC)-derived mean gradient (MG) in transcatheter aortic valve implantation (TAVI). We compared echocardiographic parameters of prosthetic valve stenosis and LHC-derived MG in new TAVIs. In a retrospective, single-center study, intraoperative transesophageal echocardiogram (TEE)-derived MG, LHC-derived MG, and acceleration time (AT) were obtained before and after TAVI in 362 patients. Discharge MG, AT, and Doppler velocity index (DVI) using transthoracic echocardiogram (TTE) were also obtained. MG ≥10 mm Hg was defined as abnormal. During native valve assessment with pre-TAVI TEE and pre-TAVI LHC, Pearson correlation coefficient revealed a nearly perfect linear relation between both methods' MGs (r = 0.97, p <0.0001). Intraoperatively, after TAVI, Spearman correlation coefficient revealed a weak-to-moderate relation between post-TAVI TEE and LHC MGs (r = 0.33, p <0.0001). Significant differences were observed in categorizations between post-TAVI TEE MG and post-TAVI AT (McNemar test p = 0.0003) and between post-TAVI TEE MG and post-TAVI LHC MG (signed-rank test p <0.0001), with TEE MG more likely to misclassify a patient as abnormal. At discharge, 30% of patients had abnormal TTE MG, whereas 0% and 0.8% of patients had abnormal DVI and AT, respectively. Discharge TTE MG was not associated with death or hospitalization for heart failure at a median follow-up of 862 days. Post-TAVI Doppler-derived MG by intraoperative TEE was higher than LHC, despite being virtually identical before implantation. At discharge, patients were more likely to be classified as abnormal using MG than DVI and AT. Elevated MG at discharge was not associated with death or hospitalization for heart failure.
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15
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Mack MJ, Adams DH. Avoidance of Patient Prosthesis Mismatch After Aortic Valve Replacement: Have We Been Too Aggressive? J Am Coll Cardiol 2023; 81:976-978. [PMID: 36889876 DOI: 10.1016/j.jacc.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 03/08/2023]
Affiliation(s)
- Michael J Mack
- Baylor Scott & White Research Institute, Plano, Texas, USA.
| | - David H Adams
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, New York, USA
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16
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Sá MP, Jacquemyn X, Van den Eynde J, Tasoudis P, Dokollari A, Torregrossa G, Sicouri S, Clavel MA, Pibarot P, Ramlawi B. Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement: Meta-Analysis of Kaplan-Meier-Derived Individual Patient Data. JACC Cardiovasc Imaging 2023; 16:298-310. [PMID: 36648055 DOI: 10.1016/j.jcmg.2022.07.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/07/2022] [Accepted: 07/15/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND It remains controversial whether prosthesis-patient mismatch (PPM) (in general considered moderate if indexed effective orifice area is 0.65-0.85 cm2/m2 and severe when <0.65 cm2/m2) affects the outcomes after transcatheter aortic valve replacement (TAVR). OBJECTIVES The purpose of this study is to evaluate the time-varying effects and association of PPM with the risk of overall mortality. METHODS Study-level meta-analysis of reconstructed time-to-event data from Kaplan-Meier curves of studies published by December 30, 2021. RESULTS In total, 23 studies met our eligibility criteria and included a total of 81,969 patients included in the Kaplan-Meier curves (19,612 with PPM and 62,357 without PPM). Patients with moderate/severe PPM had a significantly higher risk of mortality compared with those without PPM (HR: 1.09 [95% CI: 1.04-1.14]; P < 0.001). In the first 30 months after the procedure, mortality rates were significantly higher in the moderate/severe PPM group (HR: 1.1 [95% CI: 1.05-1.16]; P < 0.001). In contrast, the landmark analysis beyond 30 months yielded a reversal of the HR (0.83 [95% CI: 0.68-1.01]; P = 0.064), but without statistical significance. In the sensitivity analysis, although the authors observed that severe PPM showed higher risk of mortality in comparison with no PPM (HR: 1.25 [95% CI: 1.16-1.36]; P < 0.001), they did not observe a statistically significant difference for mortality between moderate PPM and no PPM (HR: 1.03 [95% CI: 0.96-1.10]; P = 0.398). CONCLUSIONS Severe PPM, but not moderate PPM, was associated with higher risk of mortality following TAVR. These results provide support to implementation of preventive strategies to avoid severe PPM following TAVR.
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Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA; Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA.
| | - Xander Jacquemyn
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | - Panagiotis Tasoudis
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Aleksander Dokollari
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Gianluca Torregrossa
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA; Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Serge Sicouri
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Marie-Annick Clavel
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Philippe Pibarot
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Basel Ramlawi
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA; Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
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17
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Gillam LD. Prosthesis-Patient Mismatch Following Transcatheter Aortic Valve Replacement: A New Analytic Approach Provides New Insights. JACC Cardiovasc Imaging 2023; 16:311-313. [PMID: 36123288 DOI: 10.1016/j.jcmg.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/24/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Linda D Gillam
- Department of Cardiovascular Medicine, Gagnon Cardiovascular Institute at Morristown Medical Center, Atlantic Health System, Morristown, New Jersey, USA.
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Okuno T, Tomii D, Lanz J, Heg D, Praz F, Stortecky S, Reineke D, Windecker S, Pilgrim T. 5-Year Outcomes With Self-Expanding vs Balloon-Expandable Transcatheter Aortic Valve Replacement in Patients With Small Annuli. JACC Cardiovasc Interv 2023; 16:429-440. [PMID: 36858662 DOI: 10.1016/j.jcin.2022.11.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/15/2022] [Accepted: 11/23/2022] [Indexed: 03/02/2023]
Abstract
BACKGROUND Self-expanding transcatheter heart valves (THVs) are associated with better echocardiographic hemodynamic performance than balloon-expandable THVs and are considered preferable in patients with small annuli. OBJECTIVES This study sought to compare 5-year outcomes between self-expanding vs balloon-expandable THVs in severe aortic stenosis (AS) patients with small annuli. METHODS Consecutive severe AS patients with an aortic valve annulus area <430 mm2 who underwent transcatheter aortic valve replacement (TAVR) with either the CoreValve Evolut (Medtronic) or SAPIEN (Edwards Lifesciences) THV between 2012 and 2021 were enrolled from the Bern TAVI registry. A 1:1 propensity-matched analysis was performed to account for baseline differences between groups. RESULTS A total of 723 patients were included, and propensity score matching resulted in 171 pairs. Technical success was achieved in over 85% of both groups with no significant difference. Self-expanding THVs were associated with a lower transvalvular gradient (8.0 ± 4.8 mm Hg vs 12.5 ± 4.5 mm Hg; P < 0.001), a larger effective orifice area (1.81 ± 0.46 cm2 vs 1.49 ± 0.42 cm2; P < 0.001), and a lower incidence of prosthesis-patient mismatch (19.7% vs 51.8%; P < 0.001) than balloon-expandable THVs. At 5 years, there were no significant differences in mortality (50.4% vs 39.6%; P = 0.269) between groups. Disabling stroke occurred more frequently in patients with a self-expanding THV than those with a balloon-expandable THV (6.6% vs 0.6%; P = 0.030). Similar results were obtained using inverse probability of treatment weighting in the Bern TAVI registry and the nationwide Swiss TAVI registry. CONCLUSIONS The echocardiographic hemodynamic advantage of self-expanding THVs was not associated with better clinical outcomes compared with balloon-expandable THVs up to 5 years in patients with small annuli. (Swiss TAVI Registry; NCT01368250).
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Affiliation(s)
- Taishi Okuno
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland. https://twitter.com/TaishiOkuno
| | - Daijiro Tomii
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland. https://twitter.com/DaijiroTomii
| | - Jonas Lanz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Dik Heg
- Clinical Trials Unit Bern, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland. https://twitter.com/FabienPraz
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland. https://twitter.com/StefanStortecky
| | - David Reineke
- Department of Cardiac Surgery, Inselspital, University of Bern, Bern, Switzerland. https://twitter.com/DReineke76
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
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Cosyns B, Sade LE, Gerber BL, Gimelli A, Muraru D, Maurer G, Edvardsen T. The year 2021 in the European Heart Journal: Cardiovascular Imaging Part II. Eur Heart J Cardiovasc Imaging 2023; 24:276-284. [PMID: 36718129 DOI: 10.1093/ehjci/jeac273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 02/01/2023] Open
Abstract
The European Heart Journal-Cardiovascular Imaging was launched in 2012 and has during these years become one of the leading multimodality cardiovascular imaging journals. The journal is currently ranked as Number 19 among all cardiovascular journals. It has an impressive impact factor of 9.130. The most important studies published in our Journal from 2021 will be highlighted in two reports. Part II will focus on valvular heart disease, heart failure, cardiomyopathies, and congenital heart disease, while Part I of the review has focused on studies about myocardial function and risk prediction, myocardial ischaemia, and emerging techniques in cardiovascular imaging.
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Affiliation(s)
- Bernard Cosyns
- Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Universitair ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Leyla Elif Sade
- Cardiology Department, University of Pittsburgh, University of Pittsburgh Medical Center, Heart and Vascular Institute, 200 Delafield Rd Suite 3010 and 4050, Pittsburgh, PA 15215, USA.,University of Baskent, Department of Cardiology, Yukarı Bahçelievler, Mareşal Fevzi Çakmak Cd. No: 45, 06490 Çankaya/Ankara, Turkey
| | - Bernhard L Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Av Hippocrate 10/2806, Brussels, Belgium
| | - Alessia Gimelli
- Fondazione Toscana G. Monasterio, Department of Cardiac Imaging, Via Giuseppe Moruzzi, 1, 56124 Pisa PI, Italy
| | - Denisa Muraru
- Istituto Auxologico Italiano, IRCCS, Department of Cardiology, Piazzale Brescia 20, Via Giuseppe Zucchi, 18, 20095 Cusano, Milanino MI, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Gerald Maurer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Spitalgasse 23, 1090 Wien, Austria
| | - Thor Edvardsen
- ProCardio Center for Innovation, Dept of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo Norway and Institute for clinical medicine, University of Oslo, Sognsvannsveien 9, 0372 Oslo, Norway.,KG Jebsen Cardiac Research Centre, Institute for clinical medicine, University of Oslo, Sognsvannsveien 20, NO-0424 Oslo, Norway
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20
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Sengupta PP, Tokodi M. Prosthesis-Patient Mismatch After TAVR: The New Flow of Information. JACC Cardiovasc Imaging 2023; 16:10-12. [PMID: 36599556 DOI: 10.1016/j.jcmg.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/20/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Partho P Sengupta
- Division of Cardiovascular Diseases and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
| | - Márton Tokodi
- Division of Cardiovascular Diseases and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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21
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Hecht S, Zenses AS, Bernard J, Tastet L, Côté N, de Freitas Campos Guimarães L, Paradis JM, Beaudoin J, O’Connor K, Bernier M, Dumont E, Kalavrouziotis D, Delarochellière R, Mohammadi S, Clavel MA, Rodés-Cabau J, Salaun E, Pibarot P. Hemodynamic and Clinical Outcomes in Redo-Surgical Aortic Valve Replacement vs. Transcatheter Valve-in-Valve. STRUCTURAL HEART 2022. [DOI: 10.1016/j.shj.2022.100106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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22
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Miyasaka M, Tada N. Prosthesis-patient mismatch after transcatheter aortic valve implantation. Cardiovasc Interv Ther 2022; 37:615-625. [PMID: 35708855 DOI: 10.1007/s12928-022-00865-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/08/2022] [Indexed: 01/22/2023]
Abstract
Prosthesis-patient mismatch (PPM), first described in 1978, occurs when a prosthetic valve functions normally, but has an effective orifice area that is too small relative to the patient's body surface area. It results in residual left ventricular afterload and higher transvalvular pressure gradient, which has been considered to impair prognosis. PPM following surgical aortic replacement is reportedly associated with worse clinical outcomes, such as high mortality. However, the impact of PPM on clinical outcomes after transcatheter aortic valve implantation (TAVI) remains unclear. There is conflicting evidence on the impact of PPM following TAVI due to differences across studies in terms of follow-up period, methods, patient populations, and type of bioprosthetic valve. The present review summarizes the most recent evidence on PPM after TAVI.
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Affiliation(s)
- Masaki Miyasaka
- Department of Laboratory Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, Japan. .,Cardiovascular Center, Sendai Kosei Hospital, Miyagi, Japan.
| | - Norio Tada
- Cardiovascular Center, Sendai Kosei Hospital, Miyagi, Japan
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23
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McInerney A, Rodés-Cabau J, Veiga G, López-Otero D, Muñoz-García E, Campelo-Parada F, Oteo JF, Carnero M, Tafur Soto JD, Amat-Santos IJ, Travieso A, Mohammadi S, Barbanti M, Cheema AN, Toggweiler S, Saia F, Dabrowski M, Serra V, Alfonso F, Ribeiro HB, Regueiro A, Alpieri A, Gil Ongay A, Martinez-Cereijo JM, Muñoz-García A, Matta A, Arellano Serrano C, Barrero A, Tirado-Conte G, Gonzalo N, Sanmartin XC, de la Torre Hernandez JM, Kalavrouziotis D, Maroto L, Forteza-Gil A, Cobiella J, Escaned J, Nombela-Franco L. Transcatheter versus surgical aortic valve replacement in patients with morbid obesity: a multicentre propensity score-matched analysis. EUROINTERVENTION 2022; 18:e417-e427. [PMID: 35321860 PMCID: PMC10241265 DOI: 10.4244/eij-d-21-00891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Morbidly obese (MO) patients are increasingly undergoing transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS). However, the best therapeutic strategy for these patients remains a matter for debate. AIMS Our aim was to compare the periprocedural and mid-term outcomes in MO patients undergoing TAVR versus SAVR. METHODS A multicentre retrospective study including consecutive MO patients (body mass index ≥40 kg/m2, or ≥35 kg/m2 with obesity-related comorbidities) from 18 centres undergoing either TAVR (n=860) or biological SAVR (n=696) for severe AS was performed. Propensity score matching resulted in 362 pairs. RESULTS After matching, periprocedural complications, including blood transfusion (14.1% versus 48.1%; p<0.001), stage 2-3 acute kidney injury (3.99% versus 10.1%; p=0.002), hospital-acquired pneumonia (1.7% versus 5.8%; p=0.005) and access site infection (1.5% versus 5.5%; p=0.013), were more common in the SAVR group, as was moderate to severe patient-prosthesis mismatch (PPM; 9.9% versus 39.4%; p<0.001). TAVR patients more frequently required permanent pacemaker implantation (14.4% versus 5.6%; p<0.001) and had higher rates of ≥moderate residual aortic regurgitation (3.3% versus 0%; p=0.001). SAVR was an independent predictor of moderate to severe PPM (hazard ratio [HR] 1.80, 95% confidence interval [CI]: 1.25-2.59; p=0.002), while TAVR was not. In-hospital mortality was not different between groups (3.9% for TAVR versus 6.1% for SAVR; p=0.171). Two-year outcomes (including all-cause and cardiovascular mortality, and readmissions) were similar in both groups (log-rank p>0.05 for all comparisons). Predictors of all-cause 2-year mortality differed between the groups; moderate to severe PPM was a predictor following SAVR (HR 1.78, 95% CI: 1.10-2.88; p=0.018) but not following TAVR (p=0.737). CONCLUSIONS SAVR and TAVR offer similar mid-term outcomes in MO patients with severe AS, however, TAVR offers some advantages in terms of periprocedural morbidity.
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Affiliation(s)
- Angela McInerney
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Gabriela Veiga
- Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - Diego López-Otero
- Hospital Clínico Universitario de Santiago, CIBERCV, Santiago, Spain
| | - Erika Muñoz-García
- CIBERCV Cardiology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | | | - Juan F Oteo
- Department of Cardiology and Cardiac Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Manuel Carnero
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - José D Tafur Soto
- The Ochsner Clinical School, Ochsner Medical Center, New Orleans, LA, USA
| | - Ignacio J Amat-Santos
- CIBERCV, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Alejandro Travieso
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Asim N Cheema
- Division of Cardiology, St. Michael's Hospital, Toronto University, Toronto, Ontario, Canada
| | | | - Francesco Saia
- Cardiology Unit, Cardio-Thoracic-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Maciej Dabrowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Vicenç Serra
- Hospital General Universitari Vall d'Hebrón, Barcelona, Spain
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario La Princesa, IIS-IP, CIBER-CV, Madrid, Spain
| | | | - Ander Regueiro
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, Universidad de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Alberto Alpieri
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Aritz Gil Ongay
- Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | | | - Antonio Muñoz-García
- CIBERCV Cardiology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Anthony Matta
- Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - Carlos Arellano Serrano
- Department of Cardiology and Cardiac Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Alejandro Barrero
- CIBERCV, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Nieves Gonzalo
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Xoan C Sanmartin
- Hospital Clínico Universitario de Santiago, CIBERCV, Santiago, Spain
| | | | | | - Luis Maroto
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Alberto Forteza-Gil
- Department of Cardiology and Cardiac Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Javier Cobiella
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Javier Escaned
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
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24
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Hemodynamic Performance of Two Current-Generation Transcatheter Heart Valve Prostheses in Severely Calcified Aortic Valve Stenosis. J Clin Med 2022; 11:jcm11154570. [PMID: 35956185 PMCID: PMC9369986 DOI: 10.3390/jcm11154570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/21/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Treatment of severely calcified aortic valve stenosis is associated with a higher rate of paravalvular leakage (PVL) and permanent pacemaker implantation (PPI). We hypothesized that the self-expanding transcatheter heart valve (THV) prostheses Evolut Pro (EPro) is comparable to the balloon-expandable Sapien 3 (S3) regarding hemodynamics, PPI, and clinical outcome in these patients. METHODS From 2014 to 2019, all patients with very severe calcification of the aortic valve who received an EPro or an S3 THV were included. Propensity score matching was utilized to create two groups of 170 patients. RESULTS At discharge, there was significant difference in transvalvular gradients (EPro vs. S3) (dPmean 8.1 vs. 11.1 mmHg, p ≤ 0.001) and indexed effective orifice area (EOAi) (1.1 vs. 0.9, p ≤ 0.001), as well as predicted EOAi (1 vs. 0.9, p ≤ 0.001). Moderate patient prosthesis mismatch (PPM) was significantly lower in the EPro group (17.7% vs. 38%, p ≤ 0.001), as well as severe PPM (2.9% vs. 8.8%, p = 0.03). PPI and the PVL rate as well as stroke, bleeding, vascular complication, and 30-day mortality were comparable. CONCLUSIONS In patients with severely calcified aortic valves, both THVs performed similarly in terms of 30-day mortality, PPI rate, and PVL occurrence. However, patient prothesis mismatch was observed more often in the S3 group, which might be due to the intra-annular design.
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25
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Herrmann HC, Pibarot P, Wu C, Hahn RT, Tang GHL, Abbas AE, Playford D, Ruel M, Jilaihawi H, Sathananthan J, Wood DA, De Paulis R, Bax JJ, Rodes-Cabau J, Cameron DE, Chen T, Del Nido PJ, Dweck MR, Kaneko T, Latib A, Moat N, Modine T, Popma JJ, Raben J, Smith RL, Tchetche D, Thomas MR, Vincent F, Yoganathan A, Zuckerman B, Mack MJ, Leon MB. Bioprosthetic Aortic Valve Hemodynamics: Definitions, Outcomes, and Evidence Gaps: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 80:527-544. [PMID: 35902177 DOI: 10.1016/j.jacc.2022.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/19/2022] [Accepted: 06/01/2022] [Indexed: 12/23/2022]
Abstract
A virtual workshop was organized by the Heart Valve Collaboratory to identify areas of expert consensus, areas of disagreement, and evidence gaps related to bioprosthetic aortic valve hemodynamics. Impaired functional performance of bioprosthetic aortic valve replacement is associated with adverse patient outcomes; however, this assessment is complicated by the lack of standardization for labelling, definitions, and measurement techniques, both after surgical and transcatheter valve replacement. Echocardiography remains the standard assessment methodology because of its ease of performance, widespread availability, ability to do serial measurements over time, and correlation with outcomes. Management of a high gradient after replacement requires integration of the patient's clinical status, physical examination, and multimodality imaging in addition to shared patient decisions regarding treatment options. Future priorities that are underway include efforts to standardize prosthesis sizing and labelling for both surgical and transcatheter valves as well as trials to characterize the consequences of adverse hemodynamics.
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Affiliation(s)
- Howard C Herrmann
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Philippe Pibarot
- Department of Medicine, Québec Heart and Lung Institute, Laval University, Québec City, Quebec, Canada
| | - Changfu Wu
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Rebecca T Hahn
- Columbia University Medical Center, New York, New York, USA
| | | | - Amr E Abbas
- Beaumont Hospital Royal Oak, Royal Oak, Michigan, USA
| | - David Playford
- The University of Notre Dame, Fremantle, Western Australia, Australia
| | - Marc Ruel
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Hasan Jilaihawi
- Heart Valve Center, NYU Langone Health, New York, New York, USA
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A Wood
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jeroen J Bax
- Leiden University Medical Centre, Leiden, the Netherlands
| | - Josep Rodes-Cabau
- Department of Medicine, Québec Heart and Lung Institute, Laval University, Québec City, Quebec, Canada
| | - Duke E Cameron
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tiffany Chen
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pedro J Del Nido
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Tsuyoshi Kaneko
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Neil Moat
- Abbott Structural Heart, Santa Clara, California, USA
| | - Thomas Modine
- Hopital Cardiologique de Haut Leveque, Bordeaux, France
| | | | - Jamie Raben
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Robert L Smith
- Baylor Scott and White, The Heart Hospital, Plano, Texas, USA
| | | | | | | | - Ajit Yoganathan
- Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Bram Zuckerman
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Michael J Mack
- Baylor Scott and White, The Heart Hospital, Plano, Texas, USA
| | - Martin B Leon
- Columbia University Medical Center, New York, New York, USA
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Testa L, Casenghi M, Criscione E, Van Mieghem NM, Tchétché D, Asgar AW, De Backer O, Latib A, Reimers B, Stefanini G, Trani C, Giannini F, Bartorelli A, Wojakowski W, Dabrowski M, Jagielak D, Banning AP, Kharbanda R, Moreno R, Schofer J, Brinkmann C, van Royen N, Pinto D, Serra A, Segev A, Giordano A, Brambilla N, Agnifili M, Rubbio AP, Squillace M, Oreglia J, Tanja R, McCabe JM, Abizaid A, Voskuil M, Teles R, Zoccai GB, Sondergaard L, Bedogni F. Prosthesis-patient mismatch following transcatheter aortic valve replacement for degenerated transcatheter aortic valves: the TRANSIT-PPM international project. Front Cardiovasc Med 2022; 9:931207. [PMID: 35966561 PMCID: PMC9372302 DOI: 10.3389/fcvm.2022.931207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
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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Affiliation(s)
- Luca Testa
- IRCCS Policlinico S. Donato, Milan, Italy
- *Correspondence: Luca Testa,
| | | | | | | | - Didier Tchétché
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | | | - Ole De Backer
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Azeem Latib
- Montefiore Medical Center, New York, NY, United States
| | | | - Giulio Stefanini
- CCS Humanitas Research Hospital, Rozzano-Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
| | - Carlo Trani
- Policlinico Universitario A. Gemelli, Rome, Italy
| | | | - Antonio Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy
| | | | - Maciej Dabrowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | | | | | | | - Raul Moreno
- Hospital La Paz, IdiPAZ, CIBER-CV, Madrid, Spain
| | - Joachim Schofer
- MVZ Department Structural Heart Disease at St. Georg, Hamburg, Germany
| | | | | | - Duane Pinto
- Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Antoni Serra
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Amit Segev
- The Heart and Vascular Center, Chaim Sheba Medical Center, Ramat Gan, Israel
| | | | | | | | | | | | | | - Rudolph Tanja
- Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | | | | | | | - Rui Teles
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Giuseppe Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
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Prosthesis-Patient Mismatch in Small Aortic Annuli: Self-Expandable vs. Balloon-Expandable Transcatheter Aortic Valve Replacement. J Clin Med 2022; 11:jcm11071959. [PMID: 35407567 PMCID: PMC8999619 DOI: 10.3390/jcm11071959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/15/2022] [Accepted: 03/29/2022] [Indexed: 11/19/2022] Open
Abstract
Prosthesis−patient mismatch (PPM) is associated with worse outcomes following surgical aortic valve replacement (SAVR). PPM has been identified in a significant proportion of TAVR, particularly in patients with small aortic annuli. Our objective was to evaluate the hemodynamic performances of balloon-expandable (BE) (Sapiens 3TM) versus two different self-expandable (SE) (Evolut ProTM, Accurate NeoTM) TAVR devices in patients with small aortic annulus defined by a computed tomography aortic annulus area (AAA) between 330 and 440 mm2. We enrolled 131 consecutive patients corresponding to 76 Sapiens 3 23 mm (58.0%), 26 Evolut Pro (19.9%) and 29 Accurate Neo (22.1%). Mean age was 82.5 ± 7.06 years, 22.9% of patients were male and mean Euroscore was 4.0%. Mean AAA was 374 ± 27 mm2 for Sapiens 3, 383 ± 29 mm2 for Corevalve Evolut Pro and 389 ± 25 mm2 for Accurate Neo. BE devices were associated with significantly higher rates of PPM (39.5%) as compared to SE devices (15.4% for Corevalve Evolut Pro and 6.9% for Accurate Neo) (p < 0.0001). Paravalvular leaks ≥ 2/4 were more often observed in SE devices (15.4% for Corevalve Evolut Pro and 17.2% for Accurate Neo) than in BE devices (2.6%) (p = 0.007). In conclusion, SE TAVR devices did achieve better hemodynamic results despite higher rates of paravalvular leaks. Therefore, SE TAVI devices could be considered as first choice in small aortic anatomy.
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Bleiziffer S, Rudolph TK. Patient Prosthesis Mismatch After SAVR and TAVR. Front Cardiovasc Med 2022; 9:761917. [PMID: 35433878 PMCID: PMC9005892 DOI: 10.3389/fcvm.2022.761917] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/13/2022] [Indexed: 11/23/2022] Open
Abstract
Patient-prosthesis mismatch (PPM) remains one out of many factors to be considered during decision-making for the treatment of aortic valve pathologies. The idea of adequate sizing of a prosthetic heart valve was established by Rahimtoola already in 1978. In this article, the author described the phenomenon that the orifice area of a prosthetic heart valve may be too small for the individual patient. PPM is assessed by measurement or projection of the prosthetic effective orifice area indexed to body surface area (iEOA), while it is recommended to use different cut point values for non-obese and obese patients for the categorization of moderate and severe PPM. Several factors influence the accuracy of both the projected and the measured iEOA for PPM assessment, which leads to a certain number of false assignments to the PPM or no PPM group. Despite divergent findings on the impact of PPM on clinical outcomes, there is consensus that PPM should be avoided to prevent sequelae of increased prosthetic gradients after aortic valve replacement. To prevent PPM, it is required to anticipate the iEOA of the prosthesis prior to the procedure. The use of adequate reference tables, derived from echocardiographically measured mean effective orifice area (EOA) values from preferably large numbers of patients, is most appropriate to predict the iEOA. Such tables should be used also for transcatheter heart valves in the future. During the decision-making process, all available options should be taken into account for the individual patient. If the predicted size and type of a surgical prosthesis cannot be implanted, additional surgical procedures, such as annular enlargement with the Manougian technique, or alternative procedures, such as transcatheter aortic valve implantation (TAVI) can prevent PPM. PPM prevention for TAVI patients is a new field of interest and includes anticipation of the iEOA, prosthesis selection, and procedural strategies.
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Affiliation(s)
- Sabine Bleiziffer
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
- *Correspondence: Sabine Bleiziffer
| | - Tanja K. Rudolph
- Department for General and Interventional Cardiology/Angiology, Heart and Diabetes Center North Rhine-Westphalia Bochum, University Hospital of the Ruhr University, Bad Oeynhausen, Germany
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Ternacle J, Pibarot P. Prosthesis-patient mismatch is not synonymous with elevated transvalvular pressure gradient. JTCVS OPEN 2021; 8:242-243. [PMID: 36004141 PMCID: PMC9390478 DOI: 10.1016/j.xjon.2021.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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30
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Chahal NS, Senior R. Severe Patient-Prosthesis Mismatch: Compelling Entity or an Epiphenomenon of Low Flow? Circ Cardiovasc Imaging 2021; 14:e012836. [PMID: 34384246 DOI: 10.1161/circimaging.121.012836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Navtej S Chahal
- Northwick Park Hospital, London Northwest University Hospital Trust, Harrow, United Kingdom (N.S.C., R.S.).,National Heart and Lung Institute, Imperial College, London, United Kingdom (N.S.C., R.S.)
| | - Roxy Senior
- Northwick Park Hospital, London Northwest University Hospital Trust, Harrow, United Kingdom (N.S.C., R.S.).,Royal Brompton Hospital, London, United Kingdom (R.S.).,National Heart and Lung Institute, Imperial College, London, United Kingdom (N.S.C., R.S.)
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31
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Leone PP, Fazzari F, Cannata F, Sanz-Sanchez J, Mangieri A, Monti L, Cozzi O, Stefanini GG, Bragato R, Colombo A, Reimers B, Regazzoli D. Clinical and Technical Challenges of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Implantation. Front Cardiovasc Med 2021; 8:670457. [PMID: 34150868 PMCID: PMC8211887 DOI: 10.3389/fcvm.2021.670457] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/22/2021] [Indexed: 12/30/2022] Open
Abstract
Prosthesis-patient mismatch (PPM) is present when the effective area of a prosthetic valve inserted into a patient is inferior to that of a normal human valve; the hemodynamic consequence of a valve too small compared with the size of the patient's body is the generation of higher than expected transprosthetic gradients. Despite evidence of increased risk of short- and long-term mortality and of structural valve degeneration in patients with PPM after surgical aortic valve replacement, its clinical impact in patients subject to transcatheter aortic valve implantation (TAVI) is yet unclear. We aim to review and update on the definition and incidence of PPM after TAVI, and its prognostic implications in the overall population and in higher-risk subgroups, such as small aortic annuli or valve-in-valve procedures. Last, we will focus on the armamentarium available in order to reduce risk of PPM when planning a TAVI procedure.
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Affiliation(s)
- Pier Pasquale Leone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | | | - Francesco Cannata
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Jorge Sanz-Sanchez
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | | | | | - Ottavia Cozzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Giulio Giuseppe Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
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32
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Ternacle J, Abbas AE, Pibarot P. Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement: Has It Become Obsolete? JACC Cardiovasc Interv 2021; 14:977-980. [PMID: 33958171 DOI: 10.1016/j.jcin.2021.03.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Julien Ternacle
- Haut-Lévêque Cardiology Hospital, University Hospital of Bordeaux, Pessac, France
| | - Amr E Abbas
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, Michigan, USA
| | - Philippe Pibarot
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, Québec, Canada.
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33
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Mendoza CE, Celli D. Determining prosthesis-patient mismatch after TAVR: Which is the best method? J Card Surg 2020; 36:197-198. [PMID: 33295035 DOI: 10.1111/jocs.15149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/10/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Cesar E Mendoza
- Division of Cardiovascular Disease, Jackson Memorial Hospital, Miami, Florida, USA
| | - Diego Celli
- Department of Internal Medicine, University of Miami Miller, Miami, Florida, USA
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34
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Affonso da Costa FD. Commentary: Prosthesis-patient mismatch, the controversy goes on. J Thorac Cardiovasc Surg 2020; 164:833-834. [PMID: 33309085 DOI: 10.1016/j.jtcvs.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 10/23/2022]
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