Impact of Patient Prosthesis Mismatch on the Outcome of Transcatheter Pulmonic Valve Implantation

Patient prosthesis mismatch (PPM) is an important factor of the outcome in transcatheter aortic valve implantation. However, the impact of PPM in transcatheter pulmonic valve implantation (TPVI) has not been studied. Based on the narrowest valve stent diameters in two views of fluoroscopy, internal...

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Bibliographic Details
Published in:The American journal of cardiology 2021-07, Vol.151, p.93-99
Main Authors: Takajo, Daiji, Forbes, Thomas J, Kobayashi, Daisuke
Format: Article
Language:English
Subjects:
Aorta
Aortic valve
Body size
Cardiac catheterization
Fluoroscopy
Heart
Heart valves
Implantation
Implants
Intervention
Intubation
Orifices
Patients
Prostheses
Pulmonary arteries
Stents
Surgical implants
Survival analysis
Transplants & implants
Ventricle
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Summary:Patient prosthesis mismatch (PPM) is an important factor of the outcome in transcatheter aortic valve implantation. However, the impact of PPM in transcatheter pulmonic valve implantation (TPVI) has not been studied. Based on the narrowest valve stent diameters in two views of fluoroscopy, internal geometric orifice area (GOA) of the valve stent was calculated and indexed by body surface area (BSA), deriving iGOA. To define PPM in TPVI, receiver operating characteristics (ROC) curve analysis for iGOA for predicting significant residual right ventricular outflow tract (RVOT) gradient was used to derive the optimal cut-off value of iGOA. Our cohort were divided into 2 groups: PPM versus non-PPM. The clinical data were compared between 2 groups. TPVI was performed using Melody valve in 101 patients. Significant RVOT residual pressure gradient (≥ 15 mmHg) was observed in 31 patients (39.6%). Over a mean follow up periods of 6.9 ± 2.7 years, 22 patients (21.8%) required repeat interventions (16 transcatheter, 11 surgical, and both in 5 patients). Based on the ROC analysis, the best cut-off value of iGOA was 1.25 cm2/m2 (area under the curve 0.873, p < 0.001) to define PPM. PPM was present in 42 patients (42%). On the Kaplan-Meier survival analysis, PPM was associated with the need of repeat intervention (p = 0.02). In conclusion, in TPVI, PPM was a strong predictor for the need of re-intervention. Considering PPM, target diameter of valve stent would depend on the patient body size and should be taken into account for optimal outcome of TPVI.
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2021.04.022