Long-Term Mortality and Impact of Implantation-Associated Factors on the Incidence of Patient-Prosthesis Mismatch After Transcatheter Aortic Valve Implantation in Patients With Small Annuli

Prosthesis-patient mismatch (PPM) is a common phenomenon after transcatheter aortic valve implantation (TAVI), especially in patients with small aortic annuli. Whether factors during implantation, such as the implantation depth, have an impact on the occurrence of PPM is currently unclear. The objectives of our study were to (1) investigate the influence of procedure planning- and implantation-related factors on the occurrence of PPM and (2) evaluate the impact of PPM on long-term mortality after TAVI. Data from 315 patients with small aortic annuli, defined as multidetector computed tomography-derived annulus area <400 mm², treated with transfemoral TAVI between 2014 and 2021 were retrospectively analyzed. TAVI was performed with ballon-expandable valves (BEVs) in 113 and self-expanding valves (SEVs) in 202 cases. PPM was defined according to Valve Academic Research Consortium 3 and follow-up was obtained within 5 years after TAVI. Overall, PPM occurred in 121 patients (38.4%) and was significantly more frequent in patients treated with BEVs (54.9%) than with SEVs (29.2%, p <0.001). Evaluation of planning- and implantation-related factors found that deeper implantation of BEVs significantly increased the risk of PPM (p = 0.014), whereas no association was observed in SEVs. The overall mortality rates at 3 and 5 years were 25.5% and 43.1%, respectively, without significant differences between patients with and without PPM. In conclusion, PPM occurred frequently, especially after BEV implantation. In these patients, implantation depth was identified as a predictor of PPM, whereas no association was found for SEV implantation. In addition, there was no difference in longer-term mortality between patients with and without PPM.