Effects of prosthesis-patient mismatch on cardiac function and clinical outcome after transcatheter aortic valve implantation

Parasca, Catalina A.; Calin, Andreea; Rosca, Monica; Botezatu, Simona; Enache, Roxana; Beladan, Carmen; Deleanu, Dan; Chioncel, Ovidiu; Bubenek-Turconi, Serban; Iliescu, Vlad A.; Popescu, Bogdan A.

doi:10.2478/rjc-2024-0022

Abstract

Background

Transcatheter aortic valve implantation (TAVI) prostheses have better hemodynamics compared to surgical prostheses, with a lower incidence of prosthesis-patient mismatch (PPM). Nonetheless, the effects of PPM have been controversial regarding clinical impact. This study aims to determine the short-term impact of PPM on cardiac function and the effect of PPM on mid-term outcome in patients undergoing transfemoral TAVI with balloon-expandable valves.

Methods

One hundred sixty consecutive patients (76.5±7.4 years, 85 men) were enrolled and examined before and 30 days after TAVI, by comprehensive echocardiogram (speckle tracking echocardiography and strain analysis). Patients were divided according to measured PPM (PPM_M) into PPM_M group: indexed effective orifice area (EOAi)≤0.85 cm²/m² (n=64), and No-PPM_M group: EOAi>0.85 cm²/m² (n=96). Predictors and predictive value of PPM_M were analyzed based on the primary endpoint, 3-year all-cause mortality.

Results

Impaired LA function was independently associated with PPM_M after TAVI (global LA strain - OR 0.92, p = 0.022). Three-year mortality was higher in the PPM_M group (23.4% vs. 10.4% in the No-PPM_M group, p=0.026).

Conclusions

Our study revealed significantly worse impairment of LA function in patients with PPM_M compared to those without PPM_M on short-term follow-up, which correlated with 3-year mortality.

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