Abstract
Backgrounds
Evaluation of prosthesis-patient mismatch (P-PM) after transcatheter aortic valve
replacement (TAVR) by transthoracic echocardiography (TTE) has provided conflicting
results regarding its impact on outcomes. Whether post-TAVR computed tomography angiography
(CTA) evaluation of P-PM can improve our understanding is unknown. We aimed to evaluate
the inter-modality (TTE vs. CTA) agreement, inter-valve platform (balloon-expanding
valve [BEV] vs. self-expandable valve [SEV]) differences in P-PM severity, and outcomes
related to P-PM after TAVR.
Methods
We analyzed patients with both CTA and TTE before and after TAVR. Indexed effective
orifice area was calculated using two methods: TTE-derived left ventricular outflow
tract (LVOT) area from measured diameter and post-TAVR CTA-measured area. Body size
specific cut-offs for P-PM severity were used: for body mass index (BMI) < 30 kg/m2, moderate = 0.66–0.85 cm2/m2 and severe≤0.65 cm2/m2; for BMI ≥30 kg/m2, moderate = 0.56–0.70 cm2/m2 and severe≤0.55 cm2/m2.
Results
A total of 447 patients were included (median age, 83 years; 54% male). The prevalence
of P-PM (moderate or severe) was lower with CTA vs. TTE (3.5% vs. 19.5%, p < 0.001).
The prevalence of P-PM measured by TTE was more common in BEV compared to SEV (p = 0.002),
while CTA assessment showed no difference in P-PM incidence and severity between TAVR
platforms (p = 0.40). In multivariable analysis, CTA-defined but not TTE-defined
P-PM was associated with mortality after TAVR (HR:3.97; 95%CI,1.55–10.2; p = 0.004).
Both CTA-defined and TTE-defined P-PM were associated with the composite of death
and heart failure rehospitalization.
Conclusion
Although post-TAVR CTA substantially downgraded the prevalence of P-PM compared to
TTE, it identified a subset of patients with clinically relevant P-PM which associated
with outcomes.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
Full access to the journal is a member benefit for SCCT Members, Login via the SCCT website to access all journal content.
Subscribe:
Subscribe to Journal of Cardiovascular Computed TomographyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Imaging for predicting and assessing prosthesis-patient mismatch after aortic valve replacement.JACC Cardiovasc Imaging. 2019; 12: 149-162
- Incidence and sequelae of prosthesis-patient mismatch in transcatheter versus surgical valve replacement in high-risk patients with severe aortic stenosis: a PARTNER trial cohort--a analysis.J Am Coll Cardiol. 2014; 64: 1323-1334
- Prosthesis-patient mismatch in high-risk patients with severe aortic stenosis: a randomized trial of a self-expanding prosthesis.J Thorac Cardiovasc Surg. 2016; 151 (1023 e1011-1013): 1014-1022
- Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice.J Am Soc Echocardiogr. 2009; 22 (quiz 101-102): 1-23
- Effect of the ellipsoid shape of the left ventricular outflow tract on the echocardiographic assessment of aortic valve area in aortic stenosis.J Cardiovasc Comput Tomogr. 2014; 8: 52-57
- Three-dimensional imaging of the left ventricular outflow tract: impact on aortic valve area estimation by the continuity equation.J Am Soc Echocardiogr. 2012; 25: 749-757
- CT-defined prosthesis-patient mismatch downgrades frequency and severity, and demonstrates No association with adverse outcomes after transcatheter aortic valve replacement.JACC Cardiovasc Interv. 2017; 10: 1578-1587
- AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American heart association task force on practice guidelines.Circulation. 2014; 129 (2014): e521-643
- ESC/EACTS Guidelines for the management of valvular heart disease.Eur Heart J. 2017; 38 (2017): 2739-2791
- Prospective evaluation for hypoattenuated leaflet thickening following transcatheter aortic valve implantation.Am J Cardiol. 2019; 123: 658-666
- Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document.J Am Coll Cardiol. 2012; 60: 1438-1454
- Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2015; 28 (e14): 1-39
- Computed tomography imaging in the context of transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR): an expert consensus document of the Society of Cardiovascular Computed Tomography.J Cardiovasc Comput Tomogr. 2019; 13: 1-20
- Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European association of cardiovascular imaging and the American society of echocardiography.J Am Soc Echocardiogr. 2017; 30: 372-392
- Recommendations for the imaging assessment of prosthetic heart valves: a report from the European association of cardiovascular imaging endorsed by the Chinese society of echocardiography, the inter-American society of echocardiography, and the Brazilian department of cardiovascular imaging.Eur Heart J Cardiovasc Imaging. 2016; 17: 589-590
- Multidetector CT predictors of prosthesis-patient mismatch in transcatheter aortic valve replacement.J Cardiovasc Comput Tomogr. 2013; 7: 248-255
- Comparison of hemodynamic performance of self-expandable CoreValve versus balloon-expandable Edwards SAPIEN aortic valves inserted by catheter for aortic stenosis.Am J Cardiol. 2013; 111: 1026-1033
- Comparison of balloon-expandable vs self-expandable valves in patients undergoing transcatheter aortic valve replacement: the CHOICE randomized clinical trial.J Am Med Assoc. 2014; 311: 1503-1514
- Prosthesis-patient mismatch after transcatheter aortic valve replacement: it is neither rare nor benign.J Am Coll Cardiol. 2018; 72: 2712-2716
- Incidence and sequelae of prosthesis-patient mismatch in transcatheter versus surgical valve replacement in high-risk patients with severe aortic stenosis: a PARTNER trial cohort-A analysis.J Am Coll Cardiol. 2014; 64: 1323-1334
- Echocardiographic results of transcatheter versus surgical aortic valve replacement in low-risk patients: the PARTNER 3 trial.Circulation. 2020; 141: 1527-1537
- Prosthesis-patient mismatch in high-risk patients with severe aortic stenosis: a randomized trial of a self-expanding prosthesis.J Thorac Cardiovasc Surg. 2016; 151 (1023.e1011-1013): 1014-1022
- Balloon-expandable versus self-expanding transcatheter aortic valve replacement.Circulation. 2020; 141: 243-259
- Impact of sapien 3 balloon-expandable versus Evolut R self-expandable transcatheter aortic valve implantation in patients with aortic stenosis: data from a nationwide analysis.Circulation. 2020; 141: 260-268
- The impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: a systematic review and meta-analysis of 34 observational studies comprising 27 186 patients with 133 141 patient-years.Eur Heart J. 2012; 33: 1518-1529
- Incidence, predictors, and clinical impact of prosthesis-patient mismatch following transcatheter aortic valve replacement in asian patients: the OCEAN-TAVI registry.JACC Cardiovasc Interv. 2018; 11: 771-780
- Prosthesis-patient mismatch following transcatheter aortic valve replacement with supra-annular and intra-annular prostheses.JACC Cardiovasc Interv. 2019; 12: 2173-2182
- Prosthesis-patient mismatch in patients undergoing transcatheter aortic valve replacement: from the STS/ACC TVT registry.J Am Coll Cardiol. 2018; 72: 2701-2711
- Obesity paradox in the clinical significance of effective prosthetic orifice area after aortic valve replacement.JACC Cardiovasc Imaging. 2019; 12: 208-210
- Determinants of aortic bioprosthetic valve calcification assessed by multidetector CT.Heart. 2015; 101: 472-477
- Prosthesis-patient mismatch predicts structural valve degeneration in bioprosthetic heart valves.Circulation. 2010; 121: 2123-2129
Article info
Publication history
Published online: January 16, 2021
Accepted:
January 12,
2021
Received in revised form:
December 28,
2020
Received:
October 12,
2020
Identification
Copyright
© 2021 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
