Prosthesis–Patient Mismatch After Transcatheter Aortic Valve Implantation

• Published in: The Annals of thoracic surgery Vol. 101; no. 3; pp. 872 - 880
• Main Authors: Takagi, Hisato, MD, PhD, Umemoto, Takuya, MD, PhD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.03.2016
• Subjects: Aortic Valve Stenosis - surgery; Cardiothoracic Surgery; Heart Valve Prosthesis - adverse effects; Humans; Postoperative Complications; Prosthesis Failure; Risk Factors; Surgery; Time Factors; Transcatheter Aortic Valve Replacement - methods
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2015.11.048

Background We reviewed currently available studies that investigated prosthesis–patient mismatch (PPM) in transcatheter aortic valve implantation (TAVI) with a systematic literature search and meta-analytic estimates. Methods To identify all studies that investigated PPM in TAVI, MEDLINE and EMBASE were searched through August 2015. Studies considered for inclusion met the following criteria: the study population included patients undergoing TAVI and outcomes included at least post-procedural PPM prevalence. We performed three quantitative meta-analyses about (1) PPM prevalence after TAVI, (2) PPM prevalence after TAVI versus surgical aortic valve replacement (SAVR), and (3) late all-cause mortality after TAVI in patients with PPM versus patients without PPM. Results We identified 21 eligible studies that included data on a total of 4,000 patients undergoing TAVI. The first meta-analyses found moderate PPM prevalence of 26.7%, severe PPM prevalence of 8.0%, and overall PPM prevalence of 35.1%. The second meta-analyses of six studies, including 745 patients, found statistically significant reductions in moderate ( p  = 0.03), severe ( p  = 0.0003), and overall ( p  = 0.02) PPM prevalence after TAVI relative to SAVR. The third meta-analyses of five studies, including 2,654 patients, found no statistically significant differences in late mortality between patients with severe PPM and patients without PPM ( p  = 0.44) and between patients with overall PPM and patients without PPM ( p  = 0.97). Conclusions Overall, moderate, and severe PPM prevalence after TAVI was 35%, 27%, and 8%, respectively, which may be less than that after SAVR. In contrast to PPM after SAVR, PPM after TAVI may not impair late survival.