Abstract 17057: The Impact of Patient-Prosthesis Mismatch on Atrial and Ventricular Remodeling After Transcatheter Aortic Valve Replacement
Background: In aortic valve surgery, patient-prosthesis mismatch (PPM) negatively affects left ventricular (LV) remodeling and clinical outcomes. The impact of PPM on LV and left atrial (LA) remodeling following transcatheter aortic valve replacement (TAVR) remains unclear.
Methods: Global longitudinal strain (GLS) and strain rate (SR) before and at midterm follow-up after TAVR were measured using speckle-tracking echocardiography.
LV filling pressures (E/e’), maximal, minimal and pre-P wave biplane LA volumes were also measured. PPM was defined as an indexed effective orifice area (EOAi) ≤0.85 cm2/m2 (severe if <0.65cm2/m2) in the presence of a morphologically normal prosthesis.
Results: Seventy-one patients (83 yrs, [77-86], 56% male) with severe AS (AVA 0.7 ± 0.2 cm2) and high surgical risk (EuroSCORE 20 ± 13%) were evaluated. At 5 months after TAVR, moderate and severe PPM were found in 21 (30%) and 6 (9%) patients, respectively. Patients without and with PPM had similar LV mass regression (Table). Analyses of the changes in LV mechanics in 64 patients revealed that the 40 patients with no PPM had significant improvement in systolic and diastolic longitudinal mechanics post-TAVR (Table). In contrast, the 24 patients with PPM had no significant change in GLS, longitudinal SR and early diastolic longitudinal SR post-TAVR. In patients without PPM a greater reduction in pre-P LA volume (36 ± 15 to 32 ± 12 in no PPM vs. 41 ± 14 to 44 ± 18 mL/m2 in PPM; P=0.02) and a trend towards a greater reduction in maximal LA volume (48 ± 17 to 45 ± 14 in no PPM vs. 58 ± 18 to 57 ± 17 mL/m2 in PPM; P=0.11) was observed post TAVR. This was accompanied by a greater reduction in E/e’ (from 13.0 ± 4.8 to 11.1 ± 6.4 in no PPM vs. from 9.9 ± 6.0 to 14.4 ± 7.0 in PPM; P=0.01).
Conclusion: In our series, PPM post TAVR was relatively common (39%) and associated with adverse impact on positive remodeling of the LV and LA. Optimal prosthesis selection and deployment should aim to avoid PPM in high-risk patients with severe AS.
- © 2013 by American Heart Association, Inc.