Incidence and Prognosis of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement for Bicuspid Aortic Stenosis

IF 11.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS JACC. Cardiovascular interventions Pub Date : 2025-02-24 DOI:10.1016/j.jcin.2024.10.002

Futoshi Yamanaka MD , Koki Shishido MD , Noriaki Moriyama MD , Tomoki Ochiai MD , Hirokazu Miyashita MD , Hiroaki Yokoyama MD , Yoichi Sugiyama MD , Fumiaki Yashima MD , Yohei Ohno MD , Hidetaka Nishina MD , Masaki Izumo MD , Masahiko Asami MD , Toru Naganuma MD , Kazuki Mizutani MD , Masahiro Yamawaki MD , Norio Tada MD , Shinichi Shirai MD , Masahiko Noguchi MD , Hiroshi Ueno MD , Kensuke Takagi MD , Kentaro Hayashida MD

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Abstract

Background

Evidence regarding the incidence of prosthesis-patient mismatch (PPM) and long-term mortality after transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve stenosis (AS) is scarce.

Objectives

This study sought to assess the incidence and prognostic impact of PPM after TAVR for bicuspid AS compared with that for tricuspid AS.

Methods

In total, 7,393 patients who underwent TAVR were prospectively enrolled in the OCEAN-TAVI (Optimized Catheter Valvular Intervention Transcatheter Aortic Valve Implantation) registry, an ongoing Japanese, multicenter registry. We analyzed 7,051 patients (median age = 85 years, 68.4% women) and identified 503 (7.1%) with bicuspid AS. We compared the incidence of PPM and long-term mortality in 497 patients with and 497 without bicuspid AS after one-to-one propensity score matching analysis.

Results

Among the 7,051 patients, moderate and severe PPM were observed in 756 (10.7%) and 92 (1.3%) patients, respectively. Upon Kaplan-Meier curve analysis of the overall cohort, severe PPM appeared to be associated with long-term mortality (log-rank test, P = 0.065). After propensity score matching analysis, moderate and severe PPM were more frequently observed among patients with tricuspid AS than patients with bicuspid AS (moderate PPM, 11.7% vs 4.4%; severe PPM, 1.4% vs 1.0%; P = 0.0001).

Conclusions

Severe PPM appeared to be associated with all-cause mortality. Moderate and severe PPM were more frequently observed in patients with tricuspid AS than patients with bicuspid AS.

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经导管主动脉瓣置换术治疗双尖瓣狭窄后假体与患者不匹配的发生率和预后。

背景：关于双尖瓣主动脉瓣狭窄（AS）患者经导管主动脉瓣置换术（TAVR）后假体-患者不匹配（PPM）发生率和长期死亡率的证据很少。目的：本研究旨在评估与三尖瓣AS相比，二尖AS TAVR后PPM的发生率和预后影响。方法：共有7393名接受TAVR的患者前瞻性地纳入了OCEAN-TAVI（经导管主动脉瓣置入术优化导管）登记，这是一项正在进行的日本多中心登记。我们分析了7051例患者（中位年龄为85岁，68.4%为女性），其中503例（7.1%）为双尖牙AS。在一对一倾向评分匹配分析后，我们比较了497例双尖牙AS患者和497例非双尖牙AS患者的PPM发病率和长期死亡率。结果：7051例患者中，中度和重度PPM分别为756例（10.7%）和92例（1.3%）。在整个队列的Kaplan-Meier曲线分析中，严重的PPM似乎与长期死亡率相关（log-rank检验，P = 0.065）。经过倾向评分匹配分析，三尖瓣AS患者中出现中度和重度PPM的频率高于二尖瓣AS患者(中度PPM， 11.7% vs 4.4%；严重PPM， 1.4% vs 1.0%；p = 0.0001)。结论：严重的PPM似乎与全因死亡率有关。中度和重度PPM在三尖瓣AS患者中比在二尖瓣AS患者中更常见。

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来源期刊

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.