Incidence of patient prosthesis mismatch following native and valve-in-valve transcatheter aortic valve replacement based on indexed aortic valve area compared to energy loss index.

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Journal of the American College of Cardiology


BACKGROUND Severe patient-prosthesis mismatch (PPM) is defined as an indexed aortic valve area (AVAi) <0.65 cm2/m2. Its effect on clinical outcomes may be unfavorable following transcatheter aortic valve replacement (TAVR). However, its incidence may be exaggerated when using AVAi, especially following valve-in-valve (ViV) TAVR. The energy loss index (ELI) accounts for pressure recovery, and its use in determining post-TAVR PPM is unknown.

Methods We retrospectively studied patients undergoing ViV and native valve (NV) TAVR from January 1, 2014, through September 1, 2018. AVAi (derived from the continuity equation) and ELI (ascending aortic area [AoA] × aortic valve area [AVA]/AoA − AVA) were measured, and PPM incidence and severity ere compared using these 2 indexes. Differences in the severity of PPM were assessed using chi-square test in SPSS version 25 (IBM, Armonk, New York).

Results A total of 297 consecutive patients were included: 37 with ViV TAVR and 260 with NV TAVR. Baseline characteristics were not statistically significant between the groups. AVAi was 0.84 ± 0.28 cm2/m2 for NV TAVR patients and 0.59 ± 0.21 cm2/m2 for ViV TAVR patients. ELI was 1.24 ± 0.66 and 0.73 ± 0.32 cm2/m2 for NV and ViV TAVR patients, respectively. In NV TAVR, severe PPM decreased from 22% to 10% (p < 0.01), moderate PPM decreased from 33% to 15% (p < 0.01), and no PPM increased from 45% to 75% (p < 0.01) when comparing PPM by AVAi and ELI, respectively. Similarly, ViV TAVR severe PPM decreased from 65% to 54% (p = 0.026), moderate PPM decreased from 30% to 11% (p < 0.01), and no PPM increased from 5% to 35% (p < 0.01) when comparing PPM by AVAi and ELI, respectively (Figure).

Conclusion The use of ELI was noted to significantly decrease the incidence and severity of PPM, particularly in NV TAVR and to a lesser extent after ViV TAVR. Further studies are needed to determine the impact of PPM by ELI on clinical outcomes.




13 Supplement

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Transcatheter Cardiovascular Therapeutics (TCT), San Francisco, CA, September 24-28, 2019.

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