"Severe PPM following TAVR in small annulus in supra versus intra-annul" by Houman Khalili, Philippe Pibarot et al.
 

Severe PPM following TAVR in small annulus in supra versus intra-annular valve

Document Type

Conference Proceeding

Publication Date

3-2022

Publication Title

Journal of the American College of Cardiology

Abstract

Background: Some studies suggest that supra-annular valve (SAV) is associated with less prosthesis patient mismatch (PPM) compared to intra-annular valve (IAV), and severe PPM is associated with mortality in patients with small annuli undergoing transcatheter aortic valve replacement (TAVR) using self-expanding valves (SEV). This study sought to describe predictors and clinical impact of severe PPM after TAVR in small annuli with all valve types.

Methods: Predictors of PPM and mortality were examined using a multicenter retrospective registry. Patients with small annuli (< 400 mm2) treated with SAV (Acurate Neo and Medtronic SEV) and IAV valves (BEV, MEV, and Portico) were included. Severe PPM was defined as indexed effective orifice area ≤ 0.65 cm2/m2 or 0.55 cm2/m2 in BMI ≥ 30 kg/m2.

Results: Incidence of severe PPM was 18%. Patients with severe PPM had higher BSA and echo gradient. Valve type, SAV, percent oversize, annular size, post procedure invasive gradient, comorbidities, and STS score were similar between severe and non-severe PPM. At 2-year follow-up, diabetes, lower EF, and lower BMI were independent predictors of all-cause mortality. In a model using STS score, only STS score (HR=1.09, 95% CI=1.03-1.16, p=0.005) was associated with mortality. Severe PPM (p=0.63) and SAV (p=0.19) were not associated with mortality.

Conclusion: In this retrospective study of patients with severe AS and small annuli undergoing TAVR with different platforms, severe PPM was not associated with mortality.

Volume

79

Issue

9 Supplement

First Page

773

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