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Background <p>Patient-prosthesis mismatch (PPM) after trans-catheter aortic valve implantation (TAVI) is a risk factor for heart failure and mortality. Assessment of PPM using transthoracic echocardiography (TTE) and presence of hypo-attenuated leaflet thickening (HALT) may lead to overestimation. Our study aimed to assess the incidence of PPM using TTE and CTA after exclusion of patients with HALT and to evaluate predictors analyzing stent geometry.</p> Methods <p>444 patients were analyzed. PPM was calculated using the continuity equation from TTE (TTE-PPM) and CTA (CT-PPM). Regression analyses were conducted for the endpoint effective orifice area (EOA) as surrogate for PPM.</p> Results <p>Severe PPM was detected in 4.5% using TTE-PPM and in 0.5% using CT-PPM. Body mass index (BMI) was identified as a predictor for a smaller EOA in each model (<i>p</i> &lt; 0.001). Using TTE-PPM and CT-PPM, a smaller valve diameter was associated with a smaller effective orifice area (EOA) (<i>p</i> &lt; 0.001). Presence of a balloon-expanding valve was associated with a smaller EOA using CT-PPM (<i>p</i> = 0.033). Stent geometry did not influence the EOA (<i>p</i> &gt; 0.05 each model). EOA did not influence overall survival (<i>p</i> &gt; 0.05 each model).</p> Conclusions <p>The incidence of severe PPM was very low and only predicted by BMI in each assessment model. Stent geometry did not influence the incidence of PPM. Overall survival was not influenced by a smaller EOA.</p> Graphical abstract <p></p>

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CT-based evaluation of patient-prosthesis mismatch after transcatheter aortic valve implantation and its influence on outcome

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年6月23日

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  • Ramona Schmitt,
  • Nils Ressler,
  • Klaus Kaier,
  • Johannes Brado,
  • Manuel Hein,
  • Martin Soschynski,
  • Dirk Westermann,
  • Franz-Josef Neumann,
  • Philipp Breitbart,
  • Philipp Ruile

摘要

Background

Patient-prosthesis mismatch (PPM) after trans-catheter aortic valve implantation (TAVI) is a risk factor for heart failure and mortality. Assessment of PPM using transthoracic echocardiography (TTE) and presence of hypo-attenuated leaflet thickening (HALT) may lead to overestimation. Our study aimed to assess the incidence of PPM using TTE and CTA after exclusion of patients with HALT and to evaluate predictors analyzing stent geometry.

Methods

444 patients were analyzed. PPM was calculated using the continuity equation from TTE (TTE-PPM) and CTA (CT-PPM). Regression analyses were conducted for the endpoint effective orifice area (EOA) as surrogate for PPM.

Results

Severe PPM was detected in 4.5% using TTE-PPM and in 0.5% using CT-PPM. Body mass index (BMI) was identified as a predictor for a smaller EOA in each model (p < 0.001). Using TTE-PPM and CT-PPM, a smaller valve diameter was associated with a smaller effective orifice area (EOA) (p < 0.001). Presence of a balloon-expanding valve was associated with a smaller EOA using CT-PPM (p = 0.033). Stent geometry did not influence the EOA (p > 0.05 each model). EOA did not influence overall survival (p > 0.05 each model).

Conclusions

The incidence of severe PPM was very low and only predicted by BMI in each assessment model. Stent geometry did not influence the incidence of PPM. Overall survival was not influenced by a smaller EOA.

Graphical abstract