BACKGROUND:This study's objective was to investigate the incidence and long-term outcomes of measured (PPMM) and predicted (PPMP) prosthesis-patient mismatch in patients undergoing valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI). AIMS:To assess the outcomes of predicted and measured PPM in patients undergoing ViV TAVI. METHODS:This retrospective, multicenter analysis included patients who underwent ViV TAVI at the Baylor Scott & White Health-Care System between 2012 and 2021. Effective orifice area (EOA) was measured at discharge using transthoracic echocardiography and indexed to body surface area (EOAi), and predicted EOAi was derived from published reference values according to valve type and size. PPM was classified using standard EOAi cutoff values and subsequently reclassified using obesity-adjusted EOAi thresholds for patients with body mass index ≥ 30 kg/m². RESULTS:A total of 162 patients treated with ViV-TAVI were analyzed: 64.8% were male, 34% had a BMI ≥ 30kg/m², and the median age was 77 [69.2; 84.0] years. The median STS risk score was 6.3 [3.5; 9.65] %. TAVI was performed trans-femorally in 95.7%, using balloon-expandable (52.5%) and self-expanding (47.5%) devices. The incidence of severe PPMP was significantly lower than that of severe PPMM, both before (14.8% vs. 28.4%, p = 0.005) and after adjusting for BMI (11.1% vs. 24.7%, p = 0.002). Both severe PPMP and PPMM predicted high residual pressure gradient (≥ 20mmHg) (p = 0.004, p = 0.002, respectively), with no statistical superiority (Delong test, p = 0.82). Five-year mortality was 52% for PPMM and 51% for PPMP. Severe-PPMM and severe-PPMP were not significantly associated to increased mortality when compared to the absence of PPMM (50% vs. 57% survival; HR 1.76, p = 0.221) or PPMP (69% vs. 58% survival; HR 0.81, p = 0.713), respectively. CONCLUSIONS:In this single healthcare system experience, neither measured PPM nor predicted PPM were predictive of 5-year mortality in patients undergoing ViV-TAVI.

Objective:Guidelines recommend a multidisciplinary heart team approach for managing complex coronary artery disease (CAD), yet its impact on clinical outcomes and adherence to recommendations is rarely reported. Methods:Between June 2021 and August 2022, 210 high-risk patients with isolated, complex CAD were evaluated at our institution's weekly heart team conference for consideration of coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), hybrid PCI/CABG, or optimal medical therapy (OMT). Adherence to recommendations and clinical outcomes, including 30-day, 1-year, and 2-year mortality, were assessed. Results:Overall adherence to heart team recommendations was 92%, with 96% adherence for CABG, 90% for PCI, 87% for OMT, and 75% for hybrid PCI/CABG. CABG was the most frequently recommended treatment (53%) and demonstrated the lowest mortality at 1 year (4%) and 2 years (6%) compared with PCI (1 year, 28%; 2 year, 40%) and OMT (1 year, 10%; 2 year, 20%). CABG patients had a lower-than-expected mortality (observed-to-expected ratio 0.9), while PCI was associated with significantly higher mortality (observed-to-expected ratio 3.0). Conclusion:This single-center multidisciplinary heart team approach for complex CAD offers a collaborative, patient-centered model that facilitates high adherence rates and favorable patient outcomes. These findings highlight the potential benefits of integrating multidisciplinary evaluation and support its implementation into standard practice for high-risk CAD patients.

Background:Prosthesis-patient mismatch (PPM) remains a topic of controversy in patients undergoing transcatheter aortic valve replacement (TAVR), particularly among women with smaller annuli. Although self-expanding valves (SEV) appear to provide superior hemodynamic performance than balloon-expandable valves, the impact of PPM severity on long-term survival, particularly regarding sex-specific differences, remains inadequately characterized. Methods:This retrospective cohort study analyzed 3016 patients (1338 women) who underwent native valve TAVR from 2012 to 2021. Patients were stratified by sex, valve type (balloon-expandable valve vs SEV), and PPM predicted (PPMP) and measured (PPMM) severity as defined by the Valve Academic Research Consortium. The primary outcome was all-cause mortality at 5 years, with secondary outcomes including PPM incidence, severity, and residual transvalvular gradients. Results:Women exhibited higher rates of severe PPMP (1.7% vs 0.1%; P < .001) and severe PPMM (7.3% vs 5.4%; P = .033). Notably, neither moderate nor severe PPMP or PPMM adversely affected 5-year survival in women (severe PPMP hazard ratio [HR], 1.24; P = .709; severe PPMM HR, 1.35; P = .168). SEVs were associated with lower overall PPMP (12.8% vs 31.8%) and PPMM (16.1% vs 31.1%) and superior hemodynamics. Although SEVs demonstrated a nonsignificant lower unadjusted survival (44.4% vs 38.0%; P = .286), 5-year survival was similar within PPM strata after risk adjustment (overall PPMP HR, 0.51; P = .510; overall PPMM HR, 0.77; P = .412). Conclusions:Despite a higher incidence and severity of both PPMP and PPMM, women did not experience decreased long-term survival after TAVR. Additionally, there was no risk-adjusted survival difference between valve types, emphasizing the need for individualized prosthesis selection and lifetime valve management considerations.

Background:While patient-prosthesis mismatch (PPM) after transcatheter aortic valve implantation (TAVI) has not been associated with increased mortality, its impact on quality of life (QoL) remains unclear. Methods:We retrospectively analyzed 3013 patients undergoing TAVI (2012-2022) within a large health care system. Patients were stratified by effective orifice area indexed to body surface area (EOAi) into no (EOAi >0.85 cm2/m2), moderate (EOAi >0.65 cm2/m2 or ≤0.85 cm2/m2), or severe (EOAi ≤0.65 cm2/m2) PPM, with lower cutoffs for obese patients (body mass index ≥30 kg/m2). Results:The median age was 80.0 (73.0; 86.0) years, and 55.6% were female with a median Society of Thoracic Surgery risk score of 4.70% (2.66; 7.64). Overall, TAVI led to significant improvements in New York Heart Association and Kansas City Cardiomyopathy Questionnaire scores at 30 days and 1 year. Severe predicted and severe measured PPm was not associated with inferior QoL outcomes improvement (all p > 0.05). Conclusion:In this large cohort, TAVI yielded substantial and durable QoL gains, regardless of PPM severity or valve type. These findings suggest that moderate or severe PPM does not diminish functional recovery and should not be a primary determinant in valve selection or procedural strategy at 1 year.

Data on the long-term outcomes of prosthesis patient mismatch (PPM) after transcatheter aortic valve implantation (TAVI) remain controversial. This study aimed to investigate the incidence and clinical outcomes of measured PPM (PPMM) and predicted PPM (PPMP) in patients who underwent TAVI. This is a retrospective analysis of 3,016 patients who underwent TAVI at a large health care system between 2012 and 2021. Effective orifice area indexed to body surface area (EOAi) was measured at discharge using the continuity equation. EOAi was predicted according to the published predictive tables for each model and size of the valve. Primary end point was 5-year survival rate. Mean age was 80 years, and 55.6% were male. The mean Society of Thoracic Surgeons risk score was 4.66%. 74.9% of patients received a balloon-expandable valve (BEV), and 25.1% received a self-expanding valve (SEV). The incidence of severe PPM was markedly lower when defined by predicted versus measured EOAi (0.8% vs 6.3%, p <0.001) and when assessed in SEV versus BEV (5.3% vs 6.6%, p = 0.02). Neither severe PPMp nor severe PPMM was associated with 5-year mortality (hazard ratio 1.26, 95% confidence interval 0.96 to 1.66, p = 0.095; hazard ratio 1.03, 95% confidence interval 0.42 to 2.49, p = 0.954, respectively), irrespective of the presence of high residual pressure gradient. Neither BEV nor SEV was associated with an increased 5-year mortality, irrespective of PPM definition or severity. In this large health care system analysis, neither severe PPMP nor severe PPMM was associated with 5-year all-cause mortality. There was no difference between BEV and SEV in terms of mortality, irrespective of the definition or severity of PPM.

Transcatheter tricuspid valve intervention (TTVI) has recently emerged as a promising alternative to surgery for tricuspid regurgitation (TR). However, a significant proportion of patients fail screening for TTVI, and little is known about their characteristics and natural history. This study sought to investigate causes of screen failure and outcomes of patients declined for TTVI. This was a retrospective single-center study of 32 patients who were ineligible for participation in TTV replacement (TTVR) and tricuspid transcatheter edge-to-edge repair (T-TEER) trials. Patients were classified into 2 groups according to the therapy they received: Optimized Medical Therapy (OMT) group or Intervention group. Mean age was 82 ±7.8 years and 68.8% were female. The most common reasons for TTVI exclusion were anatomic/procedural impediment (53.1%), inclusion criteria not met (40.6%), and multivalvular disease (6.3%). Overall, 19 patients (59.4%) did not undergo subsequent tricuspid intervention. The clinical outcomes of these patients who received OMT alone were poor, with a 1-year composite of cardiac death or heart failure readmission of 47.4%. These rates were worse than in patients who subsequently underwent an intervention, albeit not statistically significant (OMT: 47.7% vs. 23.1% Interventions, p= 0.3), and were significantly more pronounced in the subgroup of patients who were excluded for anatomic/procedural limitations (OMT: 70% vs. 14.3% Interventions, p= 0.05). In conclusion, patients ineligible for TTVI, particularly those with anatomic/procedural limitations, and treated medically have poor outcomes. These data underscore the importance of earlier referral and support the need for further transcatheter therapy iterations.

HomeCirculation: Cardiovascular InterventionsVol. 16, No. 11Valve-in-Valve Transcatheter Aortic Valve Replacement Following 2 Surgical Aortic Valve Replacements No AccessResearch ArticleRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessResearch ArticleRequest AccessFull TextValve-in-Valve Transcatheter Aortic Valve Replacement Following 2 Surgical Aortic Valve Replacements Ghadi Moubarak, Swapnil Gupta, Jonathan Ladner, Austin Kluis, Jasjit Banwait, J. Michael DiMaio, Michael J. Mack and Molly I. Szerlip Ghadi MoubarakGhadi Moubarak Correspondence to: Ghadi Moubarak, MD, Baylor Scott and White The Heart Hospital, 1100 Allied Dr, Plano, TX 75093. Email E-mail Address: [email protected] https://orcid.org/0009-0002-9280-5238 Baylor Scott and White Research Institute Plano, TX (G.M., S.G., J.L., A.K., J.B., J.M.D., M.J.M., M.I.S.). , Swapnil GuptaSwapnil Gupta Baylor Scott and White Research Institute Plano, TX (G.M., S.G., J.L., A.K., J.B., J.M.D., M.J.M., M.I.S.). , Jonathan LadnerJonathan Ladner Baylor Scott and White Research Institute Plano, TX (G.M., S.G., J.L., A.K., J.B., J.M.D., M.J.M., M.I.S.). , Austin KluisAustin Kluis Baylor Scott and White Research Institute Plano, TX (G.M., S.G., J.L., A.K., J.B., J.M.D., M.J.M., M.I.S.). , Jasjit BanwaitJasjit Banwait Baylor Scott and White Research Institute Plano, TX (G.M., S.G., J.L., A.K., J.B., J.M.D., M.J.M., M.I.S.). , J. Michael DiMaioJ. Michael DiMaio https://orcid.org/0000-0002-6064-5869 Baylor Scott and White Research Institute Plano, TX (G.M., S.G., J.L., A.K., J.B., J.M.D., M.J.M., M.I.S.). Department of Cardiothoracic Surgery (J.M.D., M.J.M.), Baylor Scott and White The Heart Hospital Plano, TX. , Michael J. MackMichael J. Mack https://orcid.org/0000-0002-3148-9158 Baylor Scott and White Research Institute Plano, TX (G.M., S.G., J.L., A.K., J.B., J.M.D., M.J.M., M.I.S.). Department of Cardiothoracic Surgery (J.M.D., M.J.M.), Baylor Scott and White The Heart Hospital Plano, TX. and Molly I. SzerlipMolly I. Szerlip https://orcid.org/0000-0002-4907-1825 Baylor Scott and White Research Institute Plano, TX (G.M., S.G., J.L., A.K., J.B., J.M.D., M.J.M., M.I.S.). Department of Cardiology (M.I.S.), Baylor Scott and White The Heart Hospital Plano, TX. Originally published21 Nov 2023https://doi.org/10.1161/CIRCINTERVENTIONS.123.013305Circulation: Cardiovascular Interventions. 2023;16FootnotesFor Sources of Funding and Disclosures, see page 729.Correspondence to: Ghadi Moubarak, MD, Baylor Scott and White The Heart Hospital, 1100 Allied Dr, Plano, TX 75093. Email ghadi.moubarak@bswhealth.orgREFERENCES1. Ad N, Holmes SD, Patel J, Pritchard G, Shuman DJ, Halpin L. Comparison of EuroSCORE II, original EuroSCORE, and the Society of Thoracic Surgeons Risk Score in cardiac surgery patients.Ann Thorac Surg. 2016; 102:573–579. doi: 10.1016/j.athoracsur.2016.01.105CrossrefMedlineGoogle Scholar2. Shaikhrezai K, Tasca G, Amrani M, Dreyfus G, Asimakopoulos G. Third-time aortic valve replacement: patient characteristics and operative outcome.Ann Thorac Surg. 2010; 89:479–483. doi: 10.1016/j.athoracsur.2009.04.044CrossrefMedlineGoogle Scholar3. Elhmidi Y, Günzinger R, Deutsch MA, Badiu CC, Krane M, Lange R. Outcomes of patients undergoing third-time aortic or mitral valve replacement.J Card Surg. 2014; 29:8–13. doi: 10.1111/jocs.12232CrossrefMedlineGoogle Scholar4. Hawkins RB, Deeb GM, Sukul D, Patel HJ, Gualano SK, Chetcuti SJ, Grossman PM, Ailawadi G, Fukuhara S. Redo surgical aortic valve replacement after prior transcatheter versus surgical aortic valve replacement.JACC Cardiovasc Interv. 2023; 16:942–953. doi: 10.1016/j.jcin.2023.03.015CrossrefMedlineGoogle Scholar5. Khatri PJ, Webb JG, Rodés-Cabau J, Fremes SE, Ruel M, Lau K, Guo H, Wijeysundera HC, Ko DT. Adverse effects associated with transcatheter aortic valve implantation: a meta-analysis of contemporary studies.Ann Intern Med. 2013; 158:35–46. doi: 10.7326/0003-4819-158-1-201301010-00007CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails November 2023Vol 16, Issue 11 Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/CIRCINTERVENTIONS.123.013305PMID: 37988438 Originally publishedNovember 21, 2023 Keywordsaortic valvebioprosthesismortalitypatientstranscatheter aortic valve replacementPDF download Advertisement SubjectsAortic Valve Replacement/Transcatheter Aortic Valve Implantation