Surgical Versus Transcatheter Aortic Valve Replacement: Impact of
Patient-Prosthesis Mismatch on Outcomes
Abstract
Background: The hemodynamics of most prosthetic valves are
often inferior to that of the normal native valve, and a significant
proportion of patients undergoing surgical (SAVR) or transcatheter
aortic valve replacement (TAVR) have high residual transaortic pressure
gradients due to prosthesis–patient mismatch (PPM). Since the
experience with TAVR has increased and long-term outcomes are reported,
a close look at the PPM literature is required in light of new evidence.
Methods: For this review, we searched the Embase, Medline, and
Cochrane databases from 2000 to 2022. Articles reporting PPM as an
outcome following aortic valve replacements were identified and
reviewed. Results: The impact of PPM on clinical outcomes
aortic valve replacement has not been clear since multiple studies
failed to report PPM incidence. However, the PPM after SAVR vary greater
than after TAVR, ranging from 8% to almost 80% in SAVR and from
24%-35% in TAVR. Incidence of severe PPM following redo SAVR is
ranging from 2 to 9% and following valve-in-valve TAVR is from 14 to
33%, however, while PPM is higher in valve-in-valve TAVR, patients had
better survival rates. Conclusions: The gap between valve
performance and clinical outcomes in TAVR and SAVR could be reduced by
carefully selecting patients for either treatment option. Understanding
predictors of PPM can add to the safety, effectiveness, and increased
survival benefit of both TAVR and SAVR.