title: Hemodynamic and clinical impact of prosthesis-patient mismatch after transcatheter aortic valve implantation.
abstract: OBJECTIVE
  This study examined the mid-term hemodynamic and clinical impact of prosthesis-patient mismatch (PPM) in patients undergoing transcatheter aortic valve implantation (TAVI) with balloon-expandable valves.
  
  
  BACKGROUND
  PPM can be observed after aortic valve surgery. However, little is known about the incidence of PPM in patients undergoing TAVI.
  
  
  METHODS
  Echocardiography and clinical assessment were performed in 165 patients at baseline, before hospital discharge, and at 6 months after TAVI. PPM was defined as an indexed effective orifice area ≤0.85 cm(2)/m(2).
  
  
  RESULTS
  Thirty patients (18.2%) showed PPM before hospital discharge. At baseline, patients with PPM had a larger body surface area (1.84 ± 0.18 m(2) vs. 1.73 ± 0.18 m(2), p = 0.003) and a greater severity of aortic stenosis (indexed valve area 0.35 ± 0.09 cm(2)/m(2) vs. 0.40 ± 0.10 cm(2)/m(2), p = 0.005) than patients without PPM. Patients with PPM demonstrated a slower and smaller reduction in mean transaortic gradient, limited left ventricular (LV) mass regression, and left atrial volume reduction over 6 months compared with patients without PPM. LV filling pressure, measured by E/e', tended to remain elevated in patients with PPM. Importantly, a higher proportion of patients with PPM did not improve in New York Heart Association functional class compared with patients without PPM (36.7% vs. 1.5%, p < 0.001), although major adverse valve-related and cardiovascular events did not differ between the 2 groups.
  
  
  CONCLUSIONS
  PPM may be observed after TAVI and when present may be accompanied by less favorable changes in transvalvular hemodynamics, limited LV mass regression, persistent elevated LV filling pressure, and less improvement in clinical functional status.
authors: Department of Cardiology and Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors: See Hooi
authors: SH
authors: Ewe
authors: Manuela
authors: M
authors: Muratori
authors: Victoria
authors: V
authors: Delgado
authors: Mauro
authors: M
authors: Pepi
authors: Gloria
authors: G
authors: Tamborini
authors: Laura
authors: L
authors: Fusini
authors: Robert J M
authors: RJ
authors: Klautz
authors: Paola
authors: P
authors: Gripari
authors: Jeroen J
authors: JJ
authors: Bax
authors: Melissa
authors: M
authors: Fusari
authors: Martin J
authors: MJ
authors: Schalij
authors: Nina Ajmone
authors: NA
authors: Marsan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001705:Bioprosthesis; D001830:Body Surface Area; D003971:Diastole; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology; D016277:Ventricular Function, Left