AUTHOR=Testa Luca , Casenghi Matteo , Criscione Enrico , Van Mieghem Nicolas M. , Tchétché Didier , Asgar Anita W. , De Backer Ole , Latib Azeem , Reimers Bernhard , Stefanini Giulio , Trani Carlo , Giannini Francesco , Bartorelli Antonio , Wojakowski Wojtek , Dabrowski Maciej , Jagielak Dariusz , Banning Adrian P. , Kharbanda Rajesh , Moreno Raul , Schofer Joachim , Brinkmann Christina , van Royen Niels , Pinto Duane , Serra Antoni , Segev Amit , Giordano Arturo , Brambilla Nedy , Agnifili Mauro , Rubbio Antonio Popolo , Squillace Mattia , Oreglia Jacopo , Tanja Rudolph , McCabe James M. , Abizaid Alexander , Voskuil Michiel , Teles Rui , Zoccai Giuseppe Biondi , Sondergaard Lars , Bedogni Francesco 

TITLE=Prosthesis-patient mismatch following transcatheter aortic valve replacement for degenerated transcatheter aortic valves: the TRANSIT-PPM international project

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.931207

DOI=10.3389/fcvm.2022.931207

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>A severe prosthesis-patient mismatch (PPM) is associated with adverse outcomes following transcatheter aortic valve replacement (TAVR) for <italic>de novo</italic> aortic stenosis or a failed surgical bioprosthesis. The impact of severe PPM in patients undergoing TAV-in-TAVR is unknown.</p></sec><sec><title>Aim</title><p>We sought to investigate the incidence and 1-year outcomes of different grades of PPM in patients undergoing TAV-in-TAVR.</p></sec><sec><title>Materials and methods</title><p>The TRANSIT-PPM is an international registry, including cases of degenerated TAVR treated with a second TAVR. PPM severity, as well as in-hospital, 30-day, and 1-year outcomes were defined according to the Valve Academic Research Consortium-3 (VARC-3) criteria.</p></sec><sec><title>Results</title><p>Among 28 centers, 155 patients were included. Severe PPM was found in 6.5% of patients, whereas moderate PPM was found in 14.2% of patients. The rate of severe PPM was higher in patients who underwent TAV-in-TAVR with a second supra-annular self-expanding (S-SE) TAVR (10%, <italic>p</italic> = 0.04). Specifically, the rate of severe PPM was significantly higher among cases of a SE TAVR implanted into a balloon-expandable (BE) device (19%, <italic>p</italic> = 0.003). At 1-year follow-up, the rate of all-cause mortality, and the rate of patients in the New York Heart Association (NYHA) class III/IV were significantly higher in the cohort of patients with severe PPM (<italic>p</italic> = 0.016 and <italic>p</italic> = 0.0001, respectively). Almost all the patients with a severe PPM after the first TAVR had a failed &lt; 23 mm BE transcatheter heart valve (THV): the treatment with an S-SE resolved the severe PPM in the majority of the cases.</p></sec><sec><title>Conclusion</title><p>After TAV-in-TAVR, in a fifth of the cases, a moderate or severe PPM occurred. A severe PPM is associated with an increased 1-year all-cause mortality.</p></sec><sec><title>Clinical trial registration</title><p>[<ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">https://clinicaltrials.gov</ext-link>], identifier [NCT04500964].</p></sec>