Prosthesis-patient mismatch is an independent predictor of congestive heart failure after transcatheter aortic valve replacement
Résumé
Background. - Little is known about the effect of prosthesis-patient mismatch (PPM) on out-comes after transcatheter aortic valve replacement. We reported previously an increased risk of PPM with the SAPIEN 3 transcatheter heart valve (S3-THV).Aims. - To investigate the association of PPM with 1-year outcomes in patients with severe aortic stenosis (AS) implanted with S3-THV.Methods. - Moderate PPM was defined by an indexed effective orifice area (iEOA) < 0.85 cm(2)/m(2), and severe PPM by an iEOA < 0.65 cm(2)/m(2). Inclusion criteria were severe symptomatic AS and implantation with S3-THV. The primary endpoint was hospitalization for congestive heart failure (CHF) at 1 year; the secondary endpoint was all-cause mortality.Results. - A total of 208 consecutive patients were included between 2016 and 2018. Male sex was prevalent (53.8%), mean age was 81.9 +/- 6.2 years, mean EuroSCORE II was 4.35 +/- 3.37, mean LVEF was 57.9 +/- 13%. Moderate and severe PPM were observed in 69 (33.2%) and 10 (4.8%) patients. Patients with PPM were younger (80.4 +/- 7 vs 82.8 +/- 5.41 years; P=0.006), had a larger BSA (1.84 +/- 0.19 vs 1.77 +/- 0.19 m(2); P=0.01), a lower iEOA (0.73 +/- 0.08 vs 1.11 +/- 0.22 cm(2)/m(2); P<0.001) and a higher mean gradient (14 +/- 4.6 vs 11.9 +/- 3.9 mmHg; P<0.001). CHF occurred in 16.5% vs 7% (P=0.03). By multivariable analysis, PPM was independently associated with CHF (hazard ratio [HR] 3.17, 95% confidence interval [CI] 1.17 to 8.55; P= 0.032), especially in patients with mitral regurgitation >= 2/4 (HR > 100, 95%CI > 100 to > 1000; P< 0.01). PPM did not correlate with alt-cause mortality (HR 0.90, 95%CI 0.22 to 3.03; P=0.86).
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