P807Patient-prosthesis mismatch after transapical aortic valve implantation: incidence and impact on survival.


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Abstract

Purpose: Transcatheter aortic valve implantation became important therapeutical option for high risk patients with sever aortic valve stenosis. Prosthesis-patient mismatch (P-PM) is an determinant of morbidity and mortality following open aortic valve replacement. Objective of our study is to evaluate P-PM incidence and impact on mid term survival in large cohort of patients treated with transapical aortic valve implantation.Methods: We included 280 patients with high to prohibitive risk for cardiac surgery (EuroScore 37 ±20 %, age 79±8) treated with Edwards Sapien valve.Effective orifice area was calculated using continuity equation and indexed with BSA. PPM risk was stratified as high (iEOA<0.65 cm2) and moderate (iEOA 0.65 to 0.85 cm2/m2).Mid term survival (30 month) was analyzed.Results: Mean EOA for all patients was 1.77 ± 0.44 cm2. 21 patients (7.3 %) have severe PPM and 76 (26.6 %) have moderate P-PM. Mean survival in all patients was 23.4 ± 0.7 month. 12 month survival rate in high risk PPM group was 66 %, in moderate risk group 80% and in none risk group 84%(high risk vs none risk p= 0.039). 30 month survival rate was not significant different between groups (Figure). PPM was unrelated to annulus size, valve size and ejection fraction. Survival was not related to geometric orifice area.Conclusion: The incidence of severe PPM is comparable with incidence after surgical aortic valve replacement (2-11 %) and at low range for moderate PPM (20-70%).Severe P-PM shows impact on early survival.

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