Prevalence and clinical impact of prosthesis patient mismatch after transcatheter aortic valve implantation

Abstract Introduction and Objectives There is ongoing debate regarding the potential clinical implications of prosthesis–patient mismatch (PPM) following transcatheter aortic valve implantation (TAVI). Our aim was to assess the prevalence of PPM in patients undergoing TAVI and its association with post-procedure clinical outcomes, as well as to identify predictors related to the development of PPM. Methods We conducted a retrospective analysis of a prospective single-center cohort of patients treated with TAVI between 2008 and 2023. Regression models were used to identify significant predictors of outcomes. PPM was defined as an indexed effective orifice area (EOA) ≤0.85 cm²/m² (severe if ≤0.65 cm²/m²) and ≤0.70 cm²/m² (severe if ≤0.55 cm²/m²) in patients with a BMI ≥30 kg/m². The EOA was calculated using the continuity equation. Results Out of a total of 1,325 post-TAVI patients, 392 (29.5%) presented with PPM, of whom 274 (20.7%) had moderate PPM and 118 (8.9%) had severe PPM. Variables significantly associated with the presence of PPM included arterial hypertension, atrial fibrillation, body surface area, and EuroSCORE II. Regarding echocardiographic characteristics, patients with better left ventricular (LV) and left atrial (LA) function at baseline showed a lower incidence of PPM (see Table). On follow-up echocardiograms, patients with PPM had higher aortic mean gradients (11.7 vs 8.8 mmHg; p