P819Incidence of patient prosthesis mismatch in patients undergoing trans-catheter aortic valve replacement (TAVI)

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Patient prosthesis mismatch (PPM) is an important factor in determining outcome after surgical aortic valve replacement (SAVR). Trans-catheter Aortic Valve Replacement (TAVI) is an increasingly important treatment option for aortic stenosis. The aim of this study was to determine the incidence of PPM following TAVI.48 patients undergoing TAVI using a Corevalve prosthesis between April 2008 and October 2010 were selected for analysis. All patients had follow up echocardiography to detect prosthesis mismatch. The continuity equation was used to calculate effective orifice area (EOA); body surface area (BSA) was used to calculate indexed effective orifice area (iEOA). Moderate mismatch was defined as an iEOA of ≤0.85cm2/m2 and severe mismatch as ≤0.65cm2/m2.The mean population age was 82 (SD 6.5; 95% CI 80-84), 56% of patients were male and the mean BMI was 26.4 kg/m2 (5.3; 24.9-27.9). Mean time to follow-up echocardiography was 190.6 days (SD 150.5; 95% CI 146.9-234.3). PPM was detected in17/48 of patients (35.4%), 12 moderate (25.0%) and 5 severe (10.4%). Mean EOA was 1.652cm2 (0.437; 1.525-1.778), mean BSA was 1.768m2 (0.207; 1.709-1.826) and mean iEOA was 0.948 cm2/m2 (0.278; 0.867-1.028). There was no significant difference between the use of 29mm or 26mm Corevalve prosthesis (P=0.489).PPM incidence in TAVI patients appears lower than in SAVR, but is still common. It remains unclear if cardiovascular outcomes will be similarly affected, and is an area for further research.

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