CT-Defined Prosthesis-Patient Mismatch Downgrades Frequency and Severity, and Demonstrates No Association With Adverse Outcomes After TAVR. 

 -  2017 
<br/><br/>Available online through MWHC library: 2008 - present 
<br/><br/> BACKGROUND: PPM does not predict mortality following transcatheter aortic valve replacement (TAVR). However, it is unknown if the EOAi<sub>CT</sub> of the left ventricular outflow tract improves risk stratification.  CONCLUSIONS: EOAi<sub>CT</sub> downgrades frequency and severity of PPM in patients after TAVR, and was not associated with mortality 1 year after TAVR. EOAi<sub>TTE</sub>, but not EOAi<sub>CT</sub>, was associated with less left ventricular mass regression. Copyright (c) 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.  METHODS: A total of 765 TAVR patients from the PARTNER II (Placement of Aortic Transcatheter Valves II) trial S3i cohort were evaluated. EOAi was calculated using the continuity equation, and the left ventricular outflow tract area was derived from baseline computed tomography. Traditional echocardiographic categories defined PPM: absent (>0.85 cm<sup>2</sup>/m<sup>2</sup>), moderate (>=0.65 and <=0.85 cm<sup>2</sup>/m<sup>2</sup>), or severe (<=0.65 cm<sup>2</sup>/m<sup>2</sup>). Correlation of EOAi<sub>CT</sub> and EOAi<sub>TTE</sub> to 1-year outcomes was performed.  OBJECTIVES: This study sought to determine if indexed effective orifice area (EOAi), using left ventricular outflow tract measured from computed tomography (EOAi<sub>CT</sub>), reclassified prosthesis-patient mismatch (PPM) compared with conventional echocardiogram-defined measurements (EOAi<sub>TTE</sub>).  RESULTS: The incidence of PPM was 24% with EOA<sub>CT</sub> compared with 45% with EOAi<sub>TTE</sub>. Only 6% of PPM was graded severe by EOAi<sub>CT</sub> compared with 9% by EOAi<sub>TTE</sub>. EOAi<sub>TTE</sub>, but not EOAi<sub>CT</sub>, defined PPM showed association with reduced left ventricular mass regression (p = 0.03 vs. p = 0.52). There was no association between PPM and death or rehospitalization at 1 year with either modality. EOA<sub>CT</sub> was associated with minor stroke at 1 year (log-rank p = 0.04), and EOAi<sub>TTE</sub> with stroke/transient ischemic attack (log-rank p = 0.030). Furthermore, when subjects with mild or greater paravalvular regurgitation were excluded, the presence of PPM did not show association with any outcome. 
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>1936-8798 
<br/><br/><label>Subjects--Topical Terms: </label><br/>*Aortic Valve Stenosis/su [Surgery]<br/>*Aortic Valve/su [Surgery]<br/>*Heart Valve Prosthesis<br/>*Postoperative Complications/dg [Diagnostic Imaging]<br/>*Tomography, X-Ray Computed<br/>*Transcatheter Aortic Valve Replacement/is [Instrumentation]<br/>Aged<br/>Aged, 80 and over<br/>Aortic Valve Stenosis/dg [Diagnostic Imaging]<br/>Aortic Valve Stenosis/mo [Mortality]<br/>Aortic Valve Stenosis/pp [Physiopathology]<br/>Aortic Valve/dg [Diagnostic Imaging]<br/>Aortic Valve/pp [Physiopathology]<br/>Area Under Curve<br/>Echocardiography, Doppler<br/>Female<br/>Humans<br/>Hypertrophy, Left Ventricular/dg [Diagnostic Imaging]<br/>Hypertrophy, Left Ventricular/pp [Physiopathology]<br/>Kaplan-Meier Estimate<br/>Male<br/>Postoperative Complications/mo [Mortality]<br/>Postoperative Complications/pc [Prevention & Control]<br/>Postoperative Complications/pp [Physiopathology]<br/>Predictive Value of Tests<br/>Prosthesis Design<br/>Registries<br/>Reproducibility of Results<br/>Risk Assessment<br/>Risk Factors<br/>ROC Curve<br/>Severity of Illness Index<br/>Transcatheter Aortic Valve Replacement/ae [Adverse Effects]<br/>Transcatheter Aortic Valve Replacement/mo [Mortality]<br/>Treatment Outcome
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar Heart & Vascular Institute
<br/><br/><label>Index Terms--Function: </label><br/>Journal Article