Author + information
- Received May 21, 2019
- Revision received July 15, 2019
- Accepted July 17, 2019
- Published online November 4, 2019.
- Taishi Okuno, MDa,
- Faisal Khan, MBBSa,
- Masahiko Asami, MDa,
- Fabien Praz, MDa,
- Dik Heg, PhDb,
- Mirjam Gauri Winkel, MDa,
- Jonas Lanz, MDa,
- Adrian Huber, MDc,
- Christoph Gräni, MD, PhDa,
- Lorenz Räber, MD, PhDa,
- Stefan Stortecky, MDa,
- Marco Valgimigli, MD, PhDa,
- Stephan Windecker, MDa and
- Thomas Pilgrim, MDa,∗ ()
- aDepartment of Cardiology, Inselspital, University of Bern, Bern, Switzerland
- bClinical Trials Unit, University of Bern, Bern, Switzerland
- cDepartment of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
- ↵∗Address for correspondence:
Dr. Thomas Pilgrim, Department of Cardiology, Inselspital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland.
Objectives This study sought to compare the frequency of prosthesis-patient mismatch (PPM) with self-expandable valves (SEV) to balloon-expandable valves (BEV).
Background PPM has been associated with increased mortality after transcatheter aortic valve replacement. Data on the frequency of PPM as a function of supra-annular or intra-annular position of transcatheter heart valves are insufficient.
Methods A total of 757 patients treated with SEV (CoreValve, Evolut R) and BEV (SAPIEN THV/XT/3) were enrolled in the present analysis between August 2007 and June 2017. PPM was classified based on discharge prosthetic effective orifice area indexed to body surface area (BSA) as severe (<0.65 cm2/m2) or moderate (0.65 to 0.85 cm2/m2) in the general population, and as severe (<0.60 cm2/m2) or moderate (0.60 to 0.90 cm2/m2) in the obese population (body mass index ≥30 kg/m2).
Results Propensity score matching resulted in 224 matched pairs. At discharge, SEV were associated with a lower incidence of PPM compared with BEV (PPM, 33.5% vs. 46.9%; p = 0.004; severe PPM, 6.7% vs. 15.6%; p = 0.003). The lower frequency of severe PPM in SEV was observed even in patients with larger annulus. Although patients with BSA >1.83 m2 had a significantly lower incidence of PPM with SEV compared with BEV, there was no significant difference in patients with BSA ≤1.83 m2. We found no impact of PPM on cardiovascular mortality or New York Heart Association functional class at 1 year.
Conclusions SEV were associated with a lower frequency of PPM compared with BEV irrespective of annulus area. The difference was mainly driven by larger patients with BSA >1.83 m2.
- aortic stenosis
- intra-annular valve
- prosthesis-patient mismatch
- supra-annular valve
- transcatheter aortic valve replacement
Dr. Praz is a consultant for Edwards Lifescience. Dr. Räber has received research grants to the institution from Abbott, Biotronik, Boston Scientific, Heartflow, Sanofi, and Regeneron; and speaker fees from Amgen, Abbott, AstraZeneca, CSL Behring, and Sanofi. Dr. Stortecky has received research grants to the institution from Edwards Lifesciences, Medtronic, and Boston Scientific; and has received honoraria for lectures from Boston Scientific. Dr. Valgimigli has received research grants to the institution from Terumo, Abbott, Medicure, and AstraZeneca; and has received honorarium fees from Bayer, Daiichi-Sankyo, Amgen, Alvimedica, iVascular, Bristol-Myers Squibb, CoreFlow, and Vifor. Dr. Windecker has received research grants to the institution from Abbott, Amgen, Bayer, Bristol-Myers Squibb, Biotronik, Boston Scientific, CSL Behring, Edwards Lifesciences, Medtronic, Polares, and Sinomed. Dr. Pilgrim has received research grants to the institution from Edwards Lifesciences, Boston Scientific, and Biotronik; and has received speaker fees from Biotronik and Boston Scientific.
All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 21, 2019.
- Revision received July 15, 2019.
- Accepted July 17, 2019.
- 2019 American College of Cardiology Foundation
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