Impact of Valve Size on Prosthesis–Patient Mismatch and Aortic Valve Gradient After Transcatheter versus Surgical Aortic Valve Replacement

Abstract

Objective

Limited data is available about the effect of implanted valve size on prosthesis–patient mismatch (PPM) incidence and aortic gradient (AG) after transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). We compared PPM incidence and postprocedural AG between TAVR and SAVR patients considering the impact of implanted valve size.

Methods

From March 20, 2012, to September 30, 2015, 563 consecutive patients underwent TAVR (n = 419) or isolated SAVR (n = 144). Postprocedural transthoracic echocardiography was obtained within 30 days; AG, effective orifice area (EOA), and EOA index were calculated.

Results

A total of 381 patients in TAVR group and 82 patients in SAVR group were included. Mean preoperative AG and mean aortic valve area were not significantly different between the 2 groups. Postprocedural AG was significantly lower in TAVR than SAVR group, 7.74 ± 5.39 versus 14.27 ± 8.16 (P < 0.001). Between patients who had TAVR and SAVR with a valve size ≤23 mm, SAVR patients were 3 times more likely to have greater than mild AG after the procedure, OR: 3.1 (95% CI, 1.1 to 8.9) (P < 0.001). PPM incidence was significantly higher in SAVR group than TAVR group, 44 (53.7%) versus 112 (29.4%), OR = 2.8 (95% CI, 1.7 to 4.5) (P < 0.001). The PPM incidence was also higher in SAVR group than TAVR group among those who had the procedures with a valve size ≤23 mm, 35 (64.8%) versus 56 (47.9%), OR = 2 (95% CI, 1.1 to 3.9) (P = 0.048). Postprocedural outcomes were comparable between the 2 groups.

Conclusions

In comparison to SAVR, TAVR is associated with less PPM and lower AG, especially in patients receiving a valve size ≤23 mm.

Keywords

TAVR SAVR prosthesis–patient mismatch aortic gradient

Get full access to this article

View all access options for this article.

References

Iung

Cachier

Baron

et al. Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery? Eur Heart J 2005; 26: 2714–2720.doi:10.1093/eurheartj/ehi471

. TAVR and SAVR: current treatment of aortic stenosis. Clin Med Insights Cardiol 2012; 6: 125–139.doi:10.4137/CMC.S7540

Makkar

RR.

Fontana

GP.

Jilaihawi

et al. Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. N Engl J Med 2012; 366: 1696–1704.doi:10.1056/NEJMoa1202277

Mack

MJ.

Leon

MB.

Smith

et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet 2015; 385: 2477–2484.doi:10.1016/S0140-6736(15)60308-7

Moat

NE.

Ludman

de Belder

et al. Long-term outcomes after transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis: the U.K. TAVI (United Kingdom transcatheter aortic valve implantation) registry. J Am Coll Cardiol 2011; 58: 2130–2138.doi:10.1016/j.jacc.2011.08.050

Piazza

Kalesan

van Mieghem

et al. A 3-center comparison of 1-year mortality outcomes between transcatheter aortic valve implantation and surgical aortic valve replacement on the basis of propensity score matching among intermediate-risk surgical patients. JACC Cardiovasc Interv 2013; 6: 443–451.doi:10.1016/j.jcin.2013.01.136

Pibarot

Dumesnil

. Prosthetic heart valves: selection of the optimal prosthesis and long-term management. Circulation 2009; 119: 1034–1048.doi:10.1161/CIRCULATIONAHA.108.778886

Pibarot

Dumesnil

. Definition prosthesis-patient mismatch: Clinical impact, and prevention. Heart 2006; 92: 1022–1029.

Ghanta

RK.

Kron

. Patient-prosthesis mismatch: surgical aortic valve replacement versus transcatheter aortic valve replacement in high risk patients with aortic stenosis. J Thorac Dis 2016; 8: E1441–E1443.doi:10.21037/jtd.2016.09.62

10.

Zorn

GL.

Little

SH.

Tadros

et al. Prosthesis-patient mismatch in high-risk patients with severe aortic stenosis: a randomized trial of a self-expanding prosthesis. J Thorac Cardiovasc Surg 2016; 151: 1014–1023.doi:10.1016/j.jtcvs.2015.10.070

11.

Rodés-Cabau

Pibarot

Suri

et al. Impact of aortic annulus size on valve hemodynamics and clinical outcomes after transcatheter and surgical aortic valve replacement: insights from the PARTNER Trial. Circ Cardiovasc Interv 2014; 7: 701–711.doi:10.1161/CIRCINTERVENTIONS.114.001681

12.

Kalavrouziotis

Rodés-Cabau

Bagur

et al. Transcatheter aortic valve implantation in patients with severe aortic stenosis and small aortic annulus. J Am Coll Cardiol 2011; 58: 1016–1024.doi:10.1016/j.jacc.2011.05.026

13.

Hahn

RT.

Pibarot

Stewart

et al. Comparison of transcatheter and surgical aortic valve replacement in severe aortic stenosis: a longitudinal study of echocardiography parameters in cohort A of the PARTNER trial (placement of aortic transcatheter valves). J Am Coll Cardiol 2013; 61: 2514–2521.doi:10.1016/j.jacc.2013.02.087

14.

Pibarot

Weissman

NJ.

Stewart

et al. Incidence and sequelae of prosthesis-patient mismatch in transcatheter versus surgical valve replacement in high-risk patients with severe aortic stenosis: a PARTNER trial cohort--a analysis. J Am Coll Cardiol 2014; 64: 1323–1334.doi:10.1016/j.jacc.2014.06.1195

15.

Aalaei-Andabili

SH.

Anderson

RD.

Petersen

et al. Comparison of periprocedural and mid-term stroke rates and outcomes between surgical aortic valve replacement and transcatheter aortic valve replacement patients. J Cardiovasc Surg 2017; 58: 591–597.doi:10.23736/S0021-9509.16.09390-3

16.

Aalaei-Andabili

SH.

Pourafshar

Bavry

et al. Acute kidney injury after transcatheter aortic valve replacement. J Card Surg 2016; 31: 416–422.doi:10.1111/jocs.12768

17.

Otto

CM.

Nishimura

. New ACC/AHA valve guidelines: aligning definitions of aortic stenosis severity with treatment recommendations. Heart 2014; 100: 902–904.doi:10.1136/heartjnl-2013-305134

18.

Zoghbi

WA.

Chambers

JB.

Dumesnil

et al. Recommendations for evaluation of prosthetic valves with echocardiography and Doppler ultrasound: a report from the American Society of echocardiography's guidelines and standards Committee and the task Force on prosthetic valves, developed in conjunction with the American College of cardiology cardiovascular imaging Committee, cardiac imaging Committee of the American Heart Association, the European association of echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of echocardiography and the Canadian Society of echocardiography, endorsed by the American College of cardiology Foundation, American Heart Association, European association of echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of echocardiography, and Canadian Society of echocardiography. J Am Soc Echocardiogr 2009; 22: 975–1014.doi:10.1016/j.echo.2009.07.013

19.

Deeb

GM.

Reardon

MJ.

Chetcuti

et al. 3-year outcomes in high-risk patients who underwent surgical or transcatheter aortic valve replacement. J Am Coll Cardiol 2016; 67: 2565–2574.doi:10.1016/j.jacc.2016.03.506

20.

Clavel

M-A.

Webb

JG.

Pibarot

et al. Comparison of the hemodynamic performance of percutaneous and surgical bioprostheses for the treatment of severe aortic stenosis. J Am Coll Cardiol 2009; 53: 1883–1891.doi:10.1016/j.jacc.2009.01.060

21.

Smith

CR.

Leon

MB.

Mack

et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 2011; 364: 2187–2198.doi:10.1056/NEJMoa1103510

22.

Thyregod

HGH.

Steinbrüchel

DA.

Ihlemann

et al. No clinical effect of prosthesis-patient mismatch after transcatheter versus surgical aortic valve replacement in intermediate- and low-risk patients with severe aortic valve stenosis at mid-term follow-up: an analysis from the NOTION trial. Eur J Cardiothorac Surg 2016; 50: 721–728.doi:10.1093/ejcts/ezw095

23.

Giannini

Petronio

AS.

Nardi

et al. Left ventricular reverse remodeling in percutaneous and surgical aortic bioprostheses: an echocardiographic study. J Am Soc Echocardiogr 2011; 24: 28–36.doi:10.1016/j.echo.2010.08.027

24.

Poulin

Yingchoncharoen

Wilson

et al. Impact of Prosthesis-Patient mismatch on left ventricular myocardial mechanics after transcatheter aortic valve replacement. J Am Heart Assoc 2016; 5: e002866. Epub ahead of print 08 Feb 2016.doi:10.1161/JAHA.115.002866

25.

Ewe

SH.

Muratori

Delgado

et al. Hemodynamic and clinical impact of prosthesis-patient mismatch after transcatheter aortic valve implantation. J Am Coll Cardiol 2011; 58: 1910–1918.doi:10.1016/j.jacc.2011.08.027

26.

Bleiziffer

Hettich

Hutter

et al. Incidence and impact of prosthesis-patient mismatch after transcatheter aortic valve implantation. J Heart Valve Dis 2013; 22: 309–316.

27.

da Silva

Sahlen

Winter

et al. Prosthesis-patient mismatch after transcatheter aortic valve implantation: impact of 2D-transthoracic echocardiography versus 3D-transesophageal echocardiography. Int J Cardiovasc Imaging 2014; 30: 1549–1557.doi:10.1007/s10554-014-0510-0