Dr. Park, Duk-woo is a cardiologist who practices in Seoul, South Korea. He earned his MBBS from Kung Hee University and his MD in cardiology from Ulsan University. Later, he completed a cardiology super specialization at the University of Ulsan. In this video Dr. Park discusses Racial Differences in the Incidence and Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement.
Link to Abstract-
The goal of this study was to assess the incidence and prognostic relevance of prosthesis-patient mismatch (PPM) following TAVR by racial groupings.
Because Asian persons have smaller annulus and valve diameters than Western ones, background PPM after TAVR may be of more concern.
From January 2015 through November 2019, the TP-TAVR (Transpacific TAVR Registry) was an international multicenter cohort study of patients with severe aortic stenosis who underwent TAVR in the United States and South Korea. At the indexed effective orifice area, PPM was classified as moderate (0.65-0.85 cm2/m2) or severe (0.655 cm2/m2). At one year, the primary outcome was a combination of mortality, stroke, or rehospitalization.
The incidence of PPM was substantially lower in the Asian population (33.6 percent; moderate, 26.5 percent; severe, 7.1 percent) than in the non-Asian population among 1,101 eligible patients (533 Asian and 569 non-Asian) (54.5 percent ; moderate, 29.8 percent ; severe, 24.7 percent ). PPM and non-PPM patients had similar 1-year rates of the primary outcome (27.5 percent vs 28.1 percent; P = 0.69); this pattern was constant for Asian (25.4 percent vs 25.2 percent; P = 0.31) and non-Asian (28.7 percent vs 32.1 percent; P = 0.97) individuals. In the overall population (HR: 0.95; 95 percent CI: 0.74-1.21), Asian patients (HR: 1.07; 95 percent CI: 0.74-1.55), and non-Asian patients (HR: 1.07; 95 percent CI: 0.74-1.55), the risk for the primary outcome did not differ significantly between the PPM and non-PPM groups after multivariable adjustment (HR: 0.86; 95 percent CI: 0.63-1.19).
The incidence of PPM was considerably lower in Asian patients than in non-Asian individuals in this study of patients with severe aortic stenosis who underwent TAVR. Regardless of racial group, the 1-year risk for the major composite outcome was similar in the PPM and non-PPM groups. (NCT03826264; Transpacific TAVR Registry [TP-TAVR])