Five‐Year Outcomes of Measured and Predicted Prosthesis‐Patient Mismatch Following Valve‐in‐Valve Transcatheter Aortic Valve Implantation

BACKGROUND: ) prosthesis-patient mismatch in patients undergoing valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI). AIMS: To assess the outcomes of predicted and measured PPM in patients undergoing ViV TAVI. METHODS: This retrospective, multicenter analysis included patients who underwent ViV TAVI at the Baylor Scott & White Health-Care System between 2012 and 2021. Effective orifice area (EOA) was measured at discharge using transthoracic echocardiography and indexed to body surface area (EOAi), and predicted EOAi was derived from published reference values according to valve type and size. PPM was classified using standard EOAi cutoff values and subsequently reclassified using obesity-adjusted EOAi thresholds for patients with body mass index ≥ 30 kg/m². RESULTS: A total of 162 patients treated with ViV-TAVI were analyzed: 64.8% were male, 34% had a BMI ≥ 30kg/m², and the median age was 77 [69.2; 84.0] years. The median STS risk score was 6.3 [3.5; 9.65] %. TAVI was performed trans-femorally in 95.7%, using balloon-expandable (52.5%) and self-expanding (47.5%) devices. The incidence of severe PPMP was significantly lower than that of severe PPMM, both before (14.8% vs. 28.4%, p = 0.005) and after adjusting for BMI (11.1% vs. 24.7%, p = 0.002). Both severe PPMP and PPMM predicted high residual pressure gradient (≥ 20mmHg) (p = 0.004, p = 0.002, respectively), with no statistical superiority (Delong test, p = 0.82). Five-year mortality was 52% for PPMM and 51% for PPMP. Severe-PPMM and severe-PPMP were not significantly associated to increased mortality when compared to the absence of PPMM (50% vs. 57% survival; HR 1.76, p = 0.221) or PPMP (69% vs. 58% survival; HR 0.81, p = 0.713), respectively. CONCLUSIONS: In this single healthcare system experience, neither measured PPM nor predicted PPM were predictive of 5-year mortality in patients undergoing ViV-TAVI.