Prevalence, predictors, and outcomes of patient prosthesis mismatch in women undergoing TAVI for severe aortic stenosis: Insights from the WIN-TAVI registry

Objective To evaluate the incidence, predictors and outcomes of female patients with patient-prosthesis mismatch (PPM) following transcatheter aortic valve intervention (TAVI) for severe aortic stenosis (AS). Background Female AS TAVI recipients have a significantly lower mortality than surgical aortic valve replacement (SAVR) recipients, which could be attributed to the potentially lower PPM rates. TAVI has been associated with lower rates of PPM compared to SAVR. PPM in females post TAVI has not been investigated to date. Methods The WIN-TAVI (Women's INternational Transcatheter Aortic Valve Implantation) registry is a multicenter registry of women undergoing TAVR for severe symptomatic AS. Two hundred and fifty patients with detailed periprocedural and follow-up echocardiographic investigations were included in the WIN-TAVI echocardiographic sub-study. PPM was defined as per European guidelines stratified by the presence of obesity. Results The incidence of PPM in our population was 32.8%. Patients with PPM had significantly higher BMI (27.4 +/- 6.1 vs. 25.2 +/- 5.0,p= .002), smaller sized valves implanted (percentage of TAVI <= 23 mm 61% vs. 29.2%, PPM vs. no PPM,p < .001) and were more often treated with balloon expandable valves (48.3 vs. 32.5%,p < .001) rather than self expanding ones (26.3 vs. 52.8%, <.001). BMI (OR = 1.08; 95%CI 1.02-1.14,p= .011) and valve size <= 23 mm (OR = 3.00 95%CI 1.14-7.94,p= .027) were the only independent predictors of PPM. There was no significant interaction between valve size and valve type (p= .203). No significant differences were observed in 1-year mortality or major adverse cardiovascular events. Conclusions PPM in females undergoing TAVI occurs in one third of patients. BMI and valve size <= 23 mm are independent predictors. Larger registries are required to determine the impact of PPM on future clinical outcomes.