The Impact of Prosthesis-Patient Mismatch on Bioprosthetic Valve Durability After Transcatheter Aortic Valve Replacement.

Background: Prosthesis-patient mismatch (PPM) is associated with structural valve deterioration after surgical aortic valve replacement. Limited evidence exists regarding its impact on hemodynamic valve deterioration (HVD) and bioprosthetic valve failure (BVF) following transcatheter aortic valve replacement (TAVR). Methods: Patients who underwent TAVR from 2013 to 2022 at UC San Diego Health with echocardiographic follow-up were retrospectively analyzed. PPM, determined by measured indexed effective orifice area, and outcomes of moderate or severe HVD and BVF were defined per Valve Academic Research Consortium 3 guidelines. Fine and Gray regression, with all-cause death as a competing risk, was used to compare the cumulative incidence of outcomes in patients with and without PPM. Results: A total of 555 patients (38.7% female, median age 81 years, median Society of Thoracic Surgeons risk score 4.2%, 96.8% balloon-expandable valves) were included. PPM occurred in 66 (11.9%) patients and was associated with higher initial post-implant mean gradient (15 mmHg IQR: 10-22 vs. 11 mmHg IQR: 8-15; Conclusions: In this single-center cohort, PPM was associated with an over two-fold increased risk of moderate or severe HVD and an over four-fold increased risk of BVF following TAVR, emphasizing the importance of pre-implant prevention.