title: Incidence and impact of prosthesis-patient mismatch after transcatheter aortic valve implantation.
abstract: OBJECTIVE
  The study aim was to investigate the incidence of patient-prosthesis mismatch (PPM) with new catheter valves, and its influence on the patients' clinical state. At present, few echocardiographic data are available on the incidence and impact of PPM with the CoreValve and Sapien prostheses for transcatheter aortic valve implantation (TAVI).
  
  
  METHODS
  The reliability of effective orifice area (EOA) measurements was assured by awaiting an interval of six months after TAVI. Of 256 survivors after TAVI, 149 complete echocardiographic data sets were available for the assessment of the indexed EOA (iEOA). In total, 106 CoreValve prostheses and 43 Sapien prostheses were implanted in this high-risk cohort (mean age 81 +/- 6 years, mean logistic EuroSCORE 20 +/- 13%).
  
  
  RESULTS
  The overall incidence of PPM (iEOA < 0.85 cm2/m2) was 61%. Patients with a larger body surface area were more likely to develop PPM (p = 0.001), while the prosthesis type, native annulus diameter, preoperative EOA, gender and prosthesis size had no influence. The mean aortic gradient was significantly higher in patients with PPM. A reduction in the left ventricular end-diastolic diameter was seen in all patients, without significant differences between groups. There were no differences in postoperative NYHA class or self-assessed health state between patients with or without PPM.
  
  
  CONCLUSIONS
  PPM was common after TAVI in the presented cohort, presumably because the native calcium masses narrow the outflow area available for blood flow. As expected for low gradients, there was no impairment of left ventricular dimension regression or clinical state of the patients, even if severe PPM was present. Based on the presented data, it is assumed that PPM might be less relevant in TAVI patients.
authors.affiliation: Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, Germany. bleiziffer@dhm.mhn.de
authors.forename: Sabine
authors.initials: S
authors.lastname: Bleiziffer
authors.forename: Ina
authors.initials: I
authors.lastname: Hettich
authors.forename: Andrea
authors.initials: A
authors.lastname: Hutter
authors.forename: Anke
authors.initials: A
authors.lastname: Wagner
authors.forename: Marcus-André
authors.initials: MA
authors.lastname: Deutsch
authors.forename: Nicolo
authors.initials: N
authors.lastname: Piazza
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Lange
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D004452:Echocardiography / Q000379:methods; D019544:Equipment Failure Analysis; D005260:Female; D005858:Germany; D006350:Heart Valve Prosthesis / Q000592:standards / Q000639:trends; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D011474:Prosthesis Design / Q000639:trends; D011475:Prosthesis Failure; D017755:Prosthesis Fitting; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome