BACKGROUND Prosthesis-patient mismatch after transcatheter aortic valve replacement (TAVR) can be measured echocardiographically (measured prosthesis-patient mismatch [PPMm]) or predicted (predicted prosthesis-patient mismatch [PPMp]) using published effective orifice area (EOA) reference values. However, the clinical implications of PPM post-TAVR remain unclear. OBJECTIVES This study aimed to elucidate the prevalence of PPMm and PPMp post-TAVR and their impact on mortality in a large international cohort. METHODS The IMPPACT TAVR (Impact of Measured or Predicted Prosthesis-pAtient mismatCh after TAVR) registry included 38,808 TAVR patients from 26 international centers. Valve Academic Research Consortium 3 criteria were used to define prosthesis-patient mismatch severity. EOA was determined echocardiographically (PPMm) or predicted (PPMp) based on core lab-derived EOA reference values. The primary endpoint was 2-year all-cause mortality. RESULTS The prevalence of PPMp (moderate: 6.8%, severe: 0.6%) was significantly lower than that of PPMm (moderate: 20.7%, severe: 4.3%; P < 0.001) with negligible correlation between the 2 methods (Kendall's tau c correlation coefficient: 0.063; P < 0.001). In unadjusted analyses, severe PPMm adversely influenced 2-year survival (HR: 1.22; 95% CI: 1.02-1.45; P = 0.027), whereas severe PPMp was not associated with outcomes (HR: 0.81; 95% CI: 0.55-1.19; P = 0.291). After adjusting for confounders, neither PPMm nor PPMp had a significant effect on 2-year all-cause mortality. CONCLUSIONS PPMm and PPMp were associated with different patient characteristics, with PPMm tending toward worse (especially low flow) and PPMp toward better (especially women) survival. After adjusting for confounders, neither PPMm nor PPMp significantly affected 2-year all-cause mortality. Hence, valve selection should not solely be based on hemodynamics but rather on a holistic approach, including patient and procedural specifics.

中文翻译：

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经导管主动脉瓣置换术后测量和预测的假体-患者错配的影响。


背景经导管主动脉瓣置换术 （TAVR） 后的人工体-患者错配可以使用已发布的有效孔口面积 （EOA） 参考值通过超声心动图（测量的人工体-患者错配 [PPMm]）或预测（预测的人工体-患者错配 [PPMp]）来测量。然而，TAVR 后 PPM 的临床意义仍不清楚。目的 本研究旨在阐明 TAVR 后 PPMm 和 PPMp 的患病率及其对大型国际队列中死亡率的影响。方法 IMPPACT TAVR （TAVR 后测量或预测的假体-pAtient mismatCh 的影响） 登记处包括来自 26 个国际中心的 38,808 名 TAVR 患者。Valve Academic Research Consortium 3 标准用于定义假体-患者错配的严重程度。EOA 是根据核心实验室得出的 EOA 参考值通过超声心动图 （PPMm） 或预测 （PPMp） 确定的。主要终点是 2 年全因死亡率。结果 PPMp 的患病率 （中度： 6.8%， 重度： 0.6%） 显著低于 PPMm 的患病率 （中度： 20.7%， 重度： 4.3%;P < 0.001），两种方法之间的相关性可以忽略不计 （Kendall 的 tau c 相关系数：0.063;P < 0.001）。在未经调整的分析中，严重的 PPMm 对 2 年生存率产生不利影响 （HR： 1.22;95% CI： 1.02-1.45;P = 0.027），而严重的 PPMp 与结果无关 （HR： 0.81;95% CI： 0.55-1.19;P = 0.291）。在调整混杂因素后，PPMm 和 PPMp 对 2 年全因死亡率均无显著影响。结论 PPMm 和 PPMp 与不同的患者特征相关，PPMm 趋于较差 （尤其是低流量），PPMp 趋向于较好 （尤其是女性） 生存。 在调整混杂因素后，PPMm 和 PPMp 均未显著影响 2 年全因死亡率。因此，瓣膜的选择不应仅基于血流动力学，而应基于整体方法，包括患者和手术细节。