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Surgical Versus Transcatheter Aortic Valve Replacement: Impact of Patient-Prosthesis Mismatch on Outcomes
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  • Ahmed Alnajar,
  • Naser Hamad,
  • Muhammad Z. Azhar,
  • Yaseen Mousa,
  • Yingyot Arora,
  • Joseph Lamelas
Ahmed Alnajar
University of Miami School of Medicine

Corresponding Author:[email protected]

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Naser Hamad
University of Miami School of Medicine
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Muhammad Z. Azhar
University of Kansas School of Medicine Wichita
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Yaseen Mousa
Florida Atlantic University
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Yingyot Arora
University of Miami School of Medicine
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Joseph Lamelas
University of Miami School of Medicine
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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.
25 Aug 2022Submitted to Journal of Cardiac Surgery
25 Aug 2022Assigned to Editor
25 Aug 2022Submission Checks Completed
29 Aug 2022Reviewer(s) Assigned
29 Oct 2022Editorial Decision: Accept
15 Nov 2022Published in Journal of Cardiac Surgery. 10.1111/jocs.17217