Objective: This study aimed to assess the predictors of patient-prosthesis mismatch (PPM) after surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) using preoperative computed tomography.
Methods: We enrolled 323 patients undergoing SAVR (n = 85) or TAVR (n = 238) for aortic stenosis. The end point was any degree of PPM (effective orifice area index <0.85 cm2/m2). We assessed the predictors of PPM after SAVR or TAVR and compared the incidence of PPM between both arms. Furthermore, we compared the hemodynamic performance using the propensity score matching.
Results: The occurrence of PPM was significantly higher in the SAVR arm (24.7% vs 7.1%; P < .001). A small sinotubular junction was an independent predictor of PPM in the SAVR arm (odds ratio, 0.79; 95% confidence interval, 0.65-0.96; P = .015), but not a significant predictor in the TAVR arm. In patients with a small sinotubular junction, the prevalence of PPM in the SAVR arm was higher (57.9% vs 2.9%; P < .001). Furthermore, among the propensity score-matched patients, the incidence of PPM in the SAVR arm was higher than that in the TAVR arm (26.3% vs 12.5%; P = .031).
Conclusions: In patients with a small sinotubular junction detected by preoperative computed tomography assessment, the incidence of PPM in patients undergoing SAVR was higher.
Keywords: aortic valve stenosis; multislice computed tomography; patient-prosthesis mismatch.
Copyright © 2018. Published by Elsevier Inc.