Effects of prosthesis-patient mismatch on cardiac function and clinical outcome after transcatheter aortic valve implantation
Artikel-Kategorie: Review
Online veröffentlicht: 19. Aug. 2024
Seitenbereich: 122 - 136
DOI: https://doi.org/10.2478/rjc-2024-0022
Schlüsselwörter
© 2024 Catalina A. Parasca et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
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 (PPMM) into PPMM group: indexed effective orifice area (EOAi)≤0.85 cm2/m2 (n=64), and No-PPMM group: EOAi>0.85 cm2/m2 (n=96). Predictors and predictive value of PPMM were analyzed based on the primary endpoint, 3-year all-cause mortality.
Results
Impaired LA function was independently associated with PPMM after TAVI (global LA strain - OR 0.92, p = 0.022). Three-year mortality was higher in the PPMM group (23.4% vs. 10.4% in the No-PPMM group, p=0.026).
Conclusions
Our study revealed significantly worse impairment of LA function in patients with PPMM compared to those without PPMM on short-term follow-up, which correlated with 3-year mortality.