{"title":"新一代球囊可扩张经导管主动脉瓣置换术后年轻和低风险患者假体-患者不匹配","authors":"Kazuki Suruga MD , Vivek Patel MS , Takashi Nagasaka MD , Yuchao Guo MD , Prateek Madaan MD , Ofir Koren MD , Dhairya Patel MPH , Izabela Harutyunyan MSN , Aakriti Gupta MD , Tarun Chakravarty MD , Wen Cheng MD , Hasan Jilaihawi MD , Mamoo Nakamura MD , Raj R. Makkar MD","doi":"10.1016/j.jcin.2025.05.003","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The clinical impact of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) is not well known in young and low-risk patients.</div></div><div><h3>Objectives</h3><div>The aim of this single-center study was to evaluate the incidence, predictors, and long-term impact of PPM in young and low-risk patients with severe native aortic stenosis (AS) following TAVR.</div></div><div><h3>Methods</h3><div>From August 2015 to December 2022, a total of 3,549 patients underwent TAVR with newer generation balloon-expandable valves. Among them, 512 patients with severe native AS who were younger than 75 years and had Society of Thoracic Surgeons scores <4% were included. All-cause and cardiovascular mortality or heart failure hospitalization during follow-up period were compared between the PPM and non-PPM groups. PPM was defined according to the Valve Academic Research Consortium-3 criteria.</div></div><div><h3>Results</h3><div>PPM was observed in 200 of 512 patients (39.0%), with moderate and severe PPM in 162 of 512 (31.6%) and 38 of 512 (7.4%), respectively. Younger age, female sex, larger body surface area, no balloon postdilation, and smaller annular area were independent predictors of PPM. Over a median follow-up duration of 1,034 days (Q1-Q3: 550-1,567 days), compared with the non-PPM group, the PPM group had significantly higher all-cause mortality (HR: 2.55; 95% CI: 1.3-5.0; <em>P</em> = 0.007), cardiovascular mortality (HR: 2.81; 95% CI: 1.1-7.5; <em>P</em> = 0.04), and heart failure hospitalization (HR: 4.43; 95% CI: 2.0-9.9; <em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>PPM is associated with worse clinical outcomes in young and low-risk patients with AS after TAVR, even with newer generation balloon-expandable valves.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"18 12","pages":"Pages 1512-1523"},"PeriodicalIF":11.4000,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prosthesis-Patient Mismatch in Young and Low-Risk Patients After Newer Generation Balloon-Expandable Transcatheter Aortic Valve Replacement\",\"authors\":\"Kazuki Suruga MD , Vivek Patel MS , Takashi Nagasaka MD , Yuchao Guo MD , Prateek Madaan MD , Ofir Koren MD , Dhairya Patel MPH , Izabela Harutyunyan MSN , Aakriti Gupta MD , Tarun Chakravarty MD , Wen Cheng MD , Hasan Jilaihawi MD , Mamoo Nakamura MD , Raj R. Makkar MD\",\"doi\":\"10.1016/j.jcin.2025.05.003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>The clinical impact of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) is not well known in young and low-risk patients.</div></div><div><h3>Objectives</h3><div>The aim of this single-center study was to evaluate the incidence, predictors, and long-term impact of PPM in young and low-risk patients with severe native aortic stenosis (AS) following TAVR.</div></div><div><h3>Methods</h3><div>From August 2015 to December 2022, a total of 3,549 patients underwent TAVR with newer generation balloon-expandable valves. Among them, 512 patients with severe native AS who were younger than 75 years and had Society of Thoracic Surgeons scores <4% were included. All-cause and cardiovascular mortality or heart failure hospitalization during follow-up period were compared between the PPM and non-PPM groups. PPM was defined according to the Valve Academic Research Consortium-3 criteria.</div></div><div><h3>Results</h3><div>PPM was observed in 200 of 512 patients (39.0%), with moderate and severe PPM in 162 of 512 (31.6%) and 38 of 512 (7.4%), respectively. Younger age, female sex, larger body surface area, no balloon postdilation, and smaller annular area were independent predictors of PPM. Over a median follow-up duration of 1,034 days (Q1-Q3: 550-1,567 days), compared with the non-PPM group, the PPM group had significantly higher all-cause mortality (HR: 2.55; 95% CI: 1.3-5.0; <em>P</em> = 0.007), cardiovascular mortality (HR: 2.81; 95% CI: 1.1-7.5; <em>P</em> = 0.04), and heart failure hospitalization (HR: 4.43; 95% CI: 2.0-9.9; <em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>PPM is associated with worse clinical outcomes in young and low-risk patients with AS after TAVR, even with newer generation balloon-expandable valves.</div></div>\",\"PeriodicalId\":14688,\"journal\":{\"name\":\"JACC. Cardiovascular interventions\",\"volume\":\"18 12\",\"pages\":\"Pages 1512-1523\"},\"PeriodicalIF\":11.4000,\"publicationDate\":\"2025-06-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JACC. Cardiovascular interventions\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1936879825013500\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JACC. Cardiovascular interventions","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1936879825013500","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Prosthesis-Patient Mismatch in Young and Low-Risk Patients After Newer Generation Balloon-Expandable Transcatheter Aortic Valve Replacement
Background
The clinical impact of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) is not well known in young and low-risk patients.
Objectives
The aim of this single-center study was to evaluate the incidence, predictors, and long-term impact of PPM in young and low-risk patients with severe native aortic stenosis (AS) following TAVR.
Methods
From August 2015 to December 2022, a total of 3,549 patients underwent TAVR with newer generation balloon-expandable valves. Among them, 512 patients with severe native AS who were younger than 75 years and had Society of Thoracic Surgeons scores <4% were included. All-cause and cardiovascular mortality or heart failure hospitalization during follow-up period were compared between the PPM and non-PPM groups. PPM was defined according to the Valve Academic Research Consortium-3 criteria.
Results
PPM was observed in 200 of 512 patients (39.0%), with moderate and severe PPM in 162 of 512 (31.6%) and 38 of 512 (7.4%), respectively. Younger age, female sex, larger body surface area, no balloon postdilation, and smaller annular area were independent predictors of PPM. Over a median follow-up duration of 1,034 days (Q1-Q3: 550-1,567 days), compared with the non-PPM group, the PPM group had significantly higher all-cause mortality (HR: 2.55; 95% CI: 1.3-5.0; P = 0.007), cardiovascular mortality (HR: 2.81; 95% CI: 1.1-7.5; P = 0.04), and heart failure hospitalization (HR: 4.43; 95% CI: 2.0-9.9; P < 0.001).
Conclusions
PPM is associated with worse clinical outcomes in young and low-risk patients with AS after TAVR, even with newer generation balloon-expandable valves.
期刊介绍:
JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.