Impact of Measured and Predicted Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement

Henning Guthoff; Mohamed Abdel-Wahab; Won-Keun Kim; Guy Witberg; Hendrik Wienemann; Maria Thurow; Jasmin Shamekhi; Clemens Eckel; Ina von der Heide; Verena Veulemans; Martin Landt; Marco Barbanti; Ariel Finkelstein; Jury Schewel; Nicolas Van Mieghem; Rik Adrichem; Stefan Toggweiler; Tobias Rheude; Luis Nombela-Franco; Ignacio J Amat-Santos; Philipp Ruile; Rodrigo Estévez-Loureiro; Matjaz Bunc; Luca Branca; Ole De Backer; Giuseppe Tarantini; Darren Mylotte; Dabit Arzamendi; Markus Pauly; Sabine Bleiziffer; Matthias Renker; Baravan Al-Kassou; Helge Möllmann; Sebastian Ludwig; Tobias Zeus; Corrado Tamburino; Tobias Schmidt; Andreas Rück; Philipp von Stein; Holger Thiele; Ahmed Abdelhafez; Matti Adam; Stephan Baldus; Tanja Rudolph; Victor Mauri; IMPPACT TAVR Investigators

doi:10.1016/j.jcin.2024.08.041

Impact of Measured and Predicted Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement

Henning Guthoff, Mohamed Abdel-Wahab, Won-Keun Kim, Guy Witberg, Hendrik Wienemann, Maria Thurow, Jasmin Shamekhi, Clemens Eckel, Ina von der Heide, Verena Veulemans, Martin Landt, Marco Barbanti, Ariel Finkelstein, Jury Schewel, Nicolas Van Mieghem, Rik Adrichem, Stefan Toggweiler, Tobias Rheude, Luis Nombela-Franco, Ignacio J Amat-SantosPhilipp Ruile, Rodrigo Estévez-Loureiro, Matjaz Bunc, Luca Branca, Ole De Backer, Giuseppe Tarantini, Darren Mylotte, Dabit Arzamendi, Markus Pauly, Sabine Bleiziffer, Matthias Renker, Baravan Al-Kassou, Helge Möllmann, Sebastian Ludwig, Tobias Zeus, Corrado Tamburino, Tobias Schmidt, Andreas Rück, Philipp von Stein, Holger Thiele, Ahmed Abdelhafez, Matti Adam, Stephan Baldus, Tanja Rudolph, Victor Mauri, IMPPACT TAVR Investigators

Department of Cardiology

11 Citations (Scopus)

Abstract

BACKGROUND: Prosthesis-patient mismatch after transcatheter aortic valve replacement (TAVR) can be measured echocardiographically (measured prosthesis-patient mismatch [PPMm]) or predicted (predicted prosthesis-patient mismatch [PPMp]) using published effective orifice area (EOA) reference values. However, the clinical implications of PPM post-TAVR remain unclear.

OBJECTIVES: This study aimed to elucidate the prevalence of PPMm and PPMp post-TAVR and their impact on mortality in a large international cohort.

METHODS: The IMPPACT TAVR (Impact of Measured or Predicted Prosthesis-pAtient mismatCh after TAVR) registry included 38,808 TAVR patients from 26 international centers. Valve Academic Research Consortium 3 criteria were used to define prosthesis-patient mismatch severity. EOA was determined echocardiographically (PPMm) or predicted (PPMp) based on core lab-derived EOA reference values. The primary endpoint was 2-year all-cause mortality.

RESULTS: The prevalence of PPMp (moderate: 6.8%, severe: 0.6%) was significantly lower than that of PPMm (moderate: 20.7%, severe: 4.3%; P < 0.001) with negligible correlation between the 2 methods (Kendall's tau c correlation coefficient: 0.063; P < 0.001). In unadjusted analyses, severe PPMm adversely influenced 2-year survival (HR: 1.22; 95% CI: 1.02-1.45; P = 0.027), whereas severe PPMp was not associated with outcomes (HR: 0.81; 95% CI: 0.55-1.19; P = 0.291). After adjusting for confounders, neither PPMm nor PPMp had a significant effect on 2-year all-cause mortality.

CONCLUSIONS: PPMm and PPMp were associated with different patient characteristics, with PPMm tending toward worse (especially low flow) and PPMp toward better (especially women) survival. After adjusting for confounders, neither PPMm nor PPMp significantly affected 2-year all-cause mortality. Hence, valve selection should not solely be based on hemodynamics but rather on a holistic approach, including patient and procedural specifics.

Original language	English
Journal	JACC. Cardiovascular interventions
Volume	17
Issue number	22
Pages (from-to)	2626-2635
Number of pages	10
ISSN	1936-8798
DOIs	https://doi.org/10.1016/j.jcin.2024.08.041
Publication status	Published - 25 Nov 2024

Keywords

effective orifice area
predictors of mortality
prevalence
prosthesis-patient mismatch
transcatheter aortic valve replacement

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Guthoff, H., Abdel-Wahab, M., Kim, W.-K., Witberg, G., Wienemann, H., Thurow, M., Shamekhi, J., Eckel, C., von der Heide, I., Veulemans, V., Landt, M., Barbanti, M., Finkelstein, A., Schewel, J., Van Mieghem, N., Adrichem, R., Toggweiler, S., Rheude, T., Nombela-Franco, L., ... IMPPACT TAVR Investigators (2024). Impact of Measured and Predicted Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement. JACC. Cardiovascular interventions, 17(22), 2626-2635. https://doi.org/10.1016/j.jcin.2024.08.041

Guthoff, H, Abdel-Wahab, M, Kim, W-K, Witberg, G, Wienemann, H, Thurow, M, Shamekhi, J, Eckel, C, von der Heide, I, Veulemans, V, Landt, M, Barbanti, M, Finkelstein, A, Schewel, J, Van Mieghem, N, Adrichem, R, Toggweiler, S, Rheude, T, Nombela-Franco, L, Amat-Santos, IJ, Ruile, P, Estévez-Loureiro, R, Bunc, M, Branca, L, De Backer, O, Tarantini, G, Mylotte, D, Arzamendi, D, Pauly, M, Bleiziffer, S, Renker, M, Al-Kassou, B, Möllmann, H, Ludwig, S, Zeus, T, Tamburino, C, Schmidt, T, Rück, A, von Stein, P, Thiele, H, Abdelhafez, A, Adam, M, Baldus, S, Rudolph, T, Mauri, V & IMPPACT TAVR Investigators 2024, 'Impact of Measured and Predicted Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement', JACC. Cardiovascular interventions, vol. 17, no. 22, pp. 2626-2635. https://doi.org/10.1016/j.jcin.2024.08.041

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title = "Impact of Measured and Predicted Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement",

abstract = "BACKGROUND: Prosthesis-patient mismatch after transcatheter aortic valve replacement (TAVR) can be measured echocardiographically (measured prosthesis-patient mismatch [PPMm]) or predicted (predicted prosthesis-patient mismatch [PPMp]) using published effective orifice area (EOA) reference values. However, the clinical implications of PPM post-TAVR remain unclear.OBJECTIVES: This study aimed to elucidate the prevalence of PPMm and PPMp post-TAVR and their impact on mortality in a large international cohort.METHODS: The IMPPACT TAVR (Impact of Measured or Predicted Prosthesis-pAtient mismatCh after TAVR) registry included 38,808 TAVR patients from 26 international centers. Valve Academic Research Consortium 3 criteria were used to define prosthesis-patient mismatch severity. EOA was determined echocardiographically (PPMm) or predicted (PPMp) based on core lab-derived EOA reference values. The primary endpoint was 2-year all-cause mortality.RESULTS: The prevalence of PPMp (moderate: 6.8\%, severe: 0.6\%) was significantly lower than that of PPMm (moderate: 20.7\%, severe: 4.3\%; P < 0.001) with negligible correlation between the 2 methods (Kendall's tau c correlation coefficient: 0.063; P < 0.001). In unadjusted analyses, severe PPMm adversely influenced 2-year survival (HR: 1.22; 95\% CI: 1.02-1.45; P = 0.027), whereas severe PPMp was not associated with outcomes (HR: 0.81; 95\% CI: 0.55-1.19; P = 0.291). After adjusting for confounders, neither PPMm nor PPMp had a significant effect on 2-year all-cause mortality.CONCLUSIONS: PPMm and PPMp were associated with different patient characteristics, with PPMm tending toward worse (especially low flow) and PPMp toward better (especially women) survival. After adjusting for confounders, neither PPMm nor PPMp significantly affected 2-year all-cause mortality. Hence, valve selection should not solely be based on hemodynamics but rather on a holistic approach, including patient and procedural specifics.",

keywords = "effective orifice area, predictors of mortality, prevalence, prosthesis-patient mismatch, transcatheter aortic valve replacement",

author = "Henning Guthoff and Mohamed Abdel-Wahab and Won-Keun Kim and Guy Witberg and Hendrik Wienemann and Maria Thurow and Jasmin Shamekhi and Clemens Eckel and \{von der Heide\}, Ina and Verena Veulemans and Martin Landt and Marco Barbanti and Ariel Finkelstein and Jury Schewel and \{Van Mieghem\}, Nicolas and Rik Adrichem and Stefan Toggweiler and Tobias Rheude and Luis Nombela-Franco and Amat-Santos, \{Ignacio J\} and Philipp Ruile and Rodrigo Est{\'e}vez-Loureiro and Matjaz Bunc and Luca Branca and \{De Backer\}, Ole and Giuseppe Tarantini and Darren Mylotte and Dabit Arzamendi and Markus Pauly and Sabine Bleiziffer and Matthias Renker and Baravan Al-Kassou and Helge M{\"o}llmann and Sebastian Ludwig and Tobias Zeus and Corrado Tamburino and Tobias Schmidt and Andreas R{\"u}ck and \{von Stein\}, Philipp and Holger Thiele and Ahmed Abdelhafez and Matti Adam and Stephan Baldus and Tanja Rudolph and Victor Mauri and \{IMPPACT TAVR Investigators\}",

year = "2024",

month = nov,

day = "25",

doi = "10.1016/j.jcin.2024.08.041",

language = "English",

volume = "17",

pages = "2626--2635",

journal = "JACC. Cardiovascular interventions",

issn = "1936-8798",

publisher = "Elsevier Inc.",

number = "22",

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TY - JOUR

T1 - Impact of Measured and Predicted Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement

AU - Guthoff, Henning

AU - Abdel-Wahab, Mohamed

AU - Kim, Won-Keun

AU - Witberg, Guy

AU - Wienemann, Hendrik

AU - Thurow, Maria

AU - Shamekhi, Jasmin

AU - Eckel, Clemens

AU - von der Heide, Ina

AU - Veulemans, Verena

AU - Landt, Martin

AU - Barbanti, Marco

AU - Finkelstein, Ariel

AU - Schewel, Jury

AU - Van Mieghem, Nicolas

AU - Adrichem, Rik

AU - Toggweiler, Stefan

AU - Rheude, Tobias

AU - Nombela-Franco, Luis

AU - Amat-Santos, Ignacio J

AU - Ruile, Philipp

AU - Estévez-Loureiro, Rodrigo

AU - Bunc, Matjaz

AU - Branca, Luca

AU - De Backer, Ole

AU - Tarantini, Giuseppe

AU - Mylotte, Darren

AU - Arzamendi, Dabit

AU - Pauly, Markus

AU - Bleiziffer, Sabine

AU - Renker, Matthias

AU - Al-Kassou, Baravan

AU - Möllmann, Helge

AU - Ludwig, Sebastian

AU - Zeus, Tobias

AU - Tamburino, Corrado

AU - Schmidt, Tobias

AU - Rück, Andreas

AU - von Stein, Philipp

AU - Thiele, Holger

AU - Abdelhafez, Ahmed

AU - Adam, Matti

AU - Baldus, Stephan

AU - Rudolph, Tanja

AU - Mauri, Victor

AU - IMPPACT TAVR Investigators

PY - 2024/11/25

Y1 - 2024/11/25

N2 - BACKGROUND: Prosthesis-patient mismatch after transcatheter aortic valve replacement (TAVR) can be measured echocardiographically (measured prosthesis-patient mismatch [PPMm]) or predicted (predicted prosthesis-patient mismatch [PPMp]) using published effective orifice area (EOA) reference values. However, the clinical implications of PPM post-TAVR remain unclear.OBJECTIVES: This study aimed to elucidate the prevalence of PPMm and PPMp post-TAVR and their impact on mortality in a large international cohort.METHODS: The IMPPACT TAVR (Impact of Measured or Predicted Prosthesis-pAtient mismatCh after TAVR) registry included 38,808 TAVR patients from 26 international centers. Valve Academic Research Consortium 3 criteria were used to define prosthesis-patient mismatch severity. EOA was determined echocardiographically (PPMm) or predicted (PPMp) based on core lab-derived EOA reference values. The primary endpoint was 2-year all-cause mortality.RESULTS: The prevalence of PPMp (moderate: 6.8%, severe: 0.6%) was significantly lower than that of PPMm (moderate: 20.7%, severe: 4.3%; P < 0.001) with negligible correlation between the 2 methods (Kendall's tau c correlation coefficient: 0.063; P < 0.001). In unadjusted analyses, severe PPMm adversely influenced 2-year survival (HR: 1.22; 95% CI: 1.02-1.45; P = 0.027), whereas severe PPMp was not associated with outcomes (HR: 0.81; 95% CI: 0.55-1.19; P = 0.291). After adjusting for confounders, neither PPMm nor PPMp had a significant effect on 2-year all-cause mortality.CONCLUSIONS: PPMm and PPMp were associated with different patient characteristics, with PPMm tending toward worse (especially low flow) and PPMp toward better (especially women) survival. After adjusting for confounders, neither PPMm nor PPMp significantly affected 2-year all-cause mortality. Hence, valve selection should not solely be based on hemodynamics but rather on a holistic approach, including patient and procedural specifics.

AB - BACKGROUND: Prosthesis-patient mismatch after transcatheter aortic valve replacement (TAVR) can be measured echocardiographically (measured prosthesis-patient mismatch [PPMm]) or predicted (predicted prosthesis-patient mismatch [PPMp]) using published effective orifice area (EOA) reference values. However, the clinical implications of PPM post-TAVR remain unclear.OBJECTIVES: This study aimed to elucidate the prevalence of PPMm and PPMp post-TAVR and their impact on mortality in a large international cohort.METHODS: The IMPPACT TAVR (Impact of Measured or Predicted Prosthesis-pAtient mismatCh after TAVR) registry included 38,808 TAVR patients from 26 international centers. Valve Academic Research Consortium 3 criteria were used to define prosthesis-patient mismatch severity. EOA was determined echocardiographically (PPMm) or predicted (PPMp) based on core lab-derived EOA reference values. The primary endpoint was 2-year all-cause mortality.RESULTS: The prevalence of PPMp (moderate: 6.8%, severe: 0.6%) was significantly lower than that of PPMm (moderate: 20.7%, severe: 4.3%; P < 0.001) with negligible correlation between the 2 methods (Kendall's tau c correlation coefficient: 0.063; P < 0.001). In unadjusted analyses, severe PPMm adversely influenced 2-year survival (HR: 1.22; 95% CI: 1.02-1.45; P = 0.027), whereas severe PPMp was not associated with outcomes (HR: 0.81; 95% CI: 0.55-1.19; P = 0.291). After adjusting for confounders, neither PPMm nor PPMp had a significant effect on 2-year all-cause mortality.CONCLUSIONS: PPMm and PPMp were associated with different patient characteristics, with PPMm tending toward worse (especially low flow) and PPMp toward better (especially women) survival. After adjusting for confounders, neither PPMm nor PPMp significantly affected 2-year all-cause mortality. Hence, valve selection should not solely be based on hemodynamics but rather on a holistic approach, including patient and procedural specifics.

KW - effective orifice area

KW - predictors of mortality

KW - prevalence

KW - prosthesis-patient mismatch

KW - transcatheter aortic valve replacement

UR - https://www.scopus.com/pages/publications/85209259316

U2 - 10.1016/j.jcin.2024.08.041

DO - 10.1016/j.jcin.2024.08.041

M3 - Journal article

C2 - 39603776

SN - 1936-8798

VL - 17

SP - 2626

EP - 2635

JO - JACC. Cardiovascular interventions

JF - JACC. Cardiovascular interventions

IS - 22

ER -

Impact of Measured and Predicted Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement

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Keywords

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