Prosthesis-patient mismatch after TAVR may not negatively impact quality of life
Prosthesis-patient mismatch (PPM) does not have a negative impact on one-year quality of life (QoL) outcomes after transcatheter aortic valve replacement (TAVR), according to new findings published in Structural Heart.[1] This appears to be true for patients receiving both self-expanding and balloon-expandable TAVR valves.
The study’s authors reviewed data from more than 3,000 patients who underwent TAVR from 2012 to 2022 at a single facility in Texas. Valve-in-valve TAVR patients were excluded. The median age was 80 years old, and 55.6% of patients were women. The median Society of Thoracic Surgeons score was 4.7%, and the median Kansas City Cardiomyopathy Questionnaire (KCCQ) score was 57.1.
All TAVR cases involved a commercially available transcatheter heart valve manufactured by Edwards Lifesciences or Medtronic. The predicted PPM rate was 21.8%, and measured PPM rate was 25.3%. The rates of severe predicted PPM and severe measured PPM were 0.8% and 6.3%, respectively.
Overall, TAVR was consistently linked to significant improvements in KCCQ scores. The median KCCQ jumped from 57.1% at baseline to 77.1 after 30 days and 81.4 after one year. PPM—either predicted or measured—was not independently associated with a worse KCCQ score.
“Although PPM may carry hemodynamic implications post-TAVR, our data and others’ support the conclusion that it does not adversely affect short- or mid-term QoL outcomes,” wrote first author Karim Al-Azizi, MD, an interventional cardiologist with Baylor Scott & White The Heart Hospital Plano, and colleagues. “Patients undergoing TAVR with self-expanding valves and balloon-expandable valves represent distinct clinical populations and were therefore analyzed separately rather than directly compared. Within each valve type, transitions in New York Heart Association functional class at 30 days and one year, as well as changes in KCCQ scores, demonstrated consistent improvement from baseline irrespective of PPM status. Importantly, neither measured nor predicted PPM, whether moderate or severe, was associated with adverse impact on functional or quality-of-life outcomes at one year.”
Al-Azizi emphasized that “aggressive procedural modifications” to mitigate PPM should not be necessary when most patients undergo TAVR. In addition, the group wrote, these data suggest that PPM should not be seen as a primary reason to choose one transcatheter heart valve type over another.
“In practical terms, prosthesis selection can be tailored more flexibly, focusing on patient anatomy, valve durability and anticipated future interventions,” the group wrote.
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.