Update on Prosthesis–Patient Mismatch Following Transcatheter Aortic Valve Replacement in Asian Patients

Background: Prosthesis–patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) is of greater concern in Asians, considering their relatively smaller annular sizes compared with Westerners. However, the prognostic significance of PPM in Asian populations has not been demonstrated. Objectives: This study aimed to elucidate the prognostic value of PPM after TAVR in Asian patients. Methods: Patients undergoing TAVR from October 2013 to December 2019 were enrolled from the OCEAN-TAVI (Optimized CathEter vAlvular iNtervention—Transcatheter Aortic Valve Implantation) registry. PPM was classified based on the indexed effective orifice area as severe (≤0.65 cm²/m²) or moderate (0.66-0.85 cm²/m²) in the general population, and severe (≤0.55 cm²/m²) or moderate (0.56-0.70 cm²/m²) in the obese population (body mass index of ≥30 kg/m²). Results: Of the 7,072 eligible patients, moderate and severe PPM were identified in 742 (10.5%) and 94 (1.3%) patients, respectively. Severe PPM relative to non-PPM was independently associated with higher adjusted risks for 3-year all-cause mortality (adjusted HR: 1.79; 95% CI: 1.16-2.78; P = 0.009) and heart failure hospitalization (adjusted HR: 1.88; 95% CI: 1.07-3.28; P = 0.027), whereas no significant difference in these outcomes was observed between moderate PPM and no PPM. Conclusions: Severe PPM following TAVR was observed in only 1.3% of our Japanese cohort, but was associated with an increased risk of mortality and heart failure hospitalization at 3 years. These results warrant the implementation of preventive strategies to obviate severe PPM after TAVR, also in Asian patients.