Research
Print page Print page
Switch language
The Capital Region of Denmark - a part of Copenhagen University Hospital
Published

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

Research output: Contribution to journalJournal articleResearchpeer-review

DOI

  1. 2019 EACTS Expert Consensus on long-term mechanical circulatory support

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Intraoperative flow profiles of arterial and venous bypass grafts to the left coronary territory

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Lung transplantation after ex vivo lung perfusion in two Scandinavian centres

    Research output: Contribution to journalJournal articleResearchpeer-review

  1. Implications of hydrodynamic testing to guide sizing of self-expanding transcatheter heart valves for valve-in-valve procedures

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Accelerated treatment of endocarditis-The POET II trial: Rationale and design of a randomized controlled trial

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Performance of the TRUE dilatation balloon valvuloplasty catheter beyond rated burst pressure: A bench study

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Early and late risk of ischemic stroke after TAVR as compared to a nationwide background population

    Research output: Contribution to journalJournal articleResearchpeer-review

  5. Valve regurgitation in patients surviving endocarditis and the subsequent risk of heart failure

    Research output: Contribution to journalJournal articleResearchpeer-review

View graph of relations

OBJECTIVES: Prosthesis-patient mismatch (PPM) after surgical aortic valve replacement (SAVR) for severe aortic valve stenosis (AVS) is common, but less common after transcatheter aortic valve replacement (TAVR) in patients considered at high risk for death after surgery. The objectives of this study were to determine incidence and clinical effect of PPM after SAVR and TAVR in a primarily low-risk patient group.

METHODS: Patients 70 years or older with severe isolated AVS, regardless of predicted operative mortality risk, were consecutively randomized 1:1 to TAVR using a self-expandable bioprosthesis (n = 145) or SAVR (n = 135). Post-procedure PPM was graded after 3 months as follows: Not present-mild, if indexed effective orifice area (iEOA) >0.85 cm(2)/m(2), moderate, if 0.65 cm(2)/m(2) < iEOA ≤ 0.85 cm(2)/m(2) and severe, if iEOA ≤0.65 cm(2)/m(2). Outcomes were major adverse cardiac and cerebrovascular events (MACCE, e.g. composite rate of all-cause death, stroke, myocardial infarction or valve reintervention), cardiac-related hospitalizations and New York Heart Association (NYHA) functional class after 2 years.

RESULTS: The incidence and the severity of PPM were significantly lower after TAVR compared with SAVR (severe, moderate, none-mild 14.0, 35.5, 50.4 vs 33.9, 36.7, 29.4%; P<0.001). PPM resulted in similar higher mean valve gradients at 3 months for both groups. Baseline characteristics related to severe PPM were younger age, absence of diabetes mellitus, lower mortality-risk score for TAVR, and younger age and higher body mass index for SAVR. At 2 years, there were numerical but no statistically significant differences between both TAVR and SAVR patients with severe and no severe PPM for MACCE (0.0 vs 12.8% for TAVR; P = 0.13, and 13.5 vs 7.0% for SAVR; P = 0.27), number of cardiac-related hospitalizations (mean ± standard deviation 0.4 ± 0.6 vs 0.6 ± 0.8; P = 0.23, and 0.4 ± 0.8 vs 0.5 ± 0.9; P = 0.70) and NYHA functional class (Class I/II/III/IV: 64.7/29.4/5.9/0.0 vs 62.1/34.7/3.2/0.0%, respectively; P = 0.91, and 71.4/25.7/2.9/0.0 vs 72.9/22.9/4.3/0.0%, respectively; P = 0.92).

CONCLUSIONS: The incidence of PPM was lower and less severe after TAVR compared with SAVR in intermediate- and low-risk patients with severe AVS. There were no significant differences in MACCE, cardiac-related hospitalizations or NYHA class after 2 years for patients with versus those without severe PPM.

Original languageEnglish
JournalEuropean journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
Volume50
Issue number4
Pages (from-to)721-728
Number of pages8
ISSN1010-7940
DOIs
Publication statusPublished - Oct 2016

ID: 49707787