Racial Differences in the Incidence and Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement

Hanbit Park; Jung Min Ahn; Do Yoon Kang; Juyong Brian Kim; Alan C. Yeung; Takeshi Nishi; William F. Fearon; Eric Page Cantey; James D. Flaherty; Charles J. Davidson; S. Christopher Malaisrie; Sehee Kim; Sung Cheol Yun; Euihong Ko; Seung Ah Lee; Dae Hee Kim; Ho Jin Kim; Joon Bum Kim; Suk Jung Choo; Duk Woo Park; Seung Jung Park

doi:10.1016/j.jcin.2021.08.038

Racial Differences in the Incidence and Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement

Hanbit Park, Jung Min Ahn, Do Yoon Kang, Juyong Brian Kim, Alan C. Yeung, Takeshi Nishi, William F. Fearon, Eric Page Cantey, James D. Flaherty, Charles J. Davidson, S. Christopher Malaisrie, Sehee Kim, Sung Cheol Yun, Euihong Ko, Seung Ah Lee, Dae Hee Kim, Ho Jin Kim, Joon Bum Kim, Suk Jung Choo, Duk Woo Park^*Seung Jung Park

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

17 Scopus citations

Abstract

Objectives: The aim of this study was to compare the incidence and prognostic significance of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) according to racial groups. Background: PPM after TAVR may be of more concern in Asian populations considering their relatively small annular and valve sizes compared with Western populations. Methods: 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 from January 2015 to November 2019. PPM was defined as moderate (0.65-0.85 cm²/m²) or severe (<0.65 cm²/m²) at the indexed effective orifice area. The primary outcome was a composite of death, stroke, or rehospitalization at 1 year. Results: Among 1,101 eligible patients (533 Asian and 569 non-Asian), the incidence of PPM was significantly lower in the Asian population (33.6%; moderate, 26.5%; severe, 7.1%) than in the non-Asian population (54.5%; moderate, 29.8%; severe, 24.7%). The 1-year rate of the primary outcome was similar between the PPM and non-PPM groups (27.5% vs 28.1%; P = 0.69); this pattern was consistent between Asian (25.4% vs 25.2%; P = 0.31) and non-Asian (28.7% vs 32.1%; P = 0.97) patients. After multivariable adjustment, the risk for the primary outcome did not significantly differ between the PPM and non-PPM groups in the overall population (HR: 0.95; 95% CI: 0.74-1.21), in Asian patients (HR: 1.07; 95% CI: 0.74-1.55), and in non-Asian patients (HR: 0.86; 95% CI: 0.63-1.19). Conclusions: In this study of patients with severe aortic stenosis who underwent TAVR, the incidence of PPM was significantly lower in Asian patients than in non-Asian patients. The 1-year risk for the primary composite outcome was similar between the PPM and non-PPM groups regardless of racial group.

Original language	English (US)
Pages (from-to)	2670-2681
Number of pages	12
Journal	JACC: Cardiovascular Interventions
Volume	14
Issue number	24
DOIs	https://doi.org/10.1016/j.jcin.2021.08.038
State	Published - Dec 27 2021

Funding

All 3 databases were standardized according to the common database model and merged in accordance with the policy of data use agreed upon among the participating centers; patient demographics, surgical risk (Society of Thoracic Surgeons Predicted Risk of Mortality score), functional status, clinical risk factors or comorbidities, anatomical or hemodynamic parameters by cardiac computed tomography or echocardiography, procedural details, and in-hospital and follow-up outcomes were collected in the common database. Each center’s Institutional Review Board or ethics committee approved the protocol for the registry. TP-TAVR was partly funded by the CardioVascular Research Foundation and was supported by a grant (2020IF0016) from Asan Institute for Life Sciences and Corporate Relations of Asan Medical Center. The sponsor had no role in the study design or in the collection, analysis, or interpretation of data. This study was supported by grant 2020IF0016 from the Asan Institute for Life Sciences and Corporate Relations of Asan Medical Center with NAVER. This study was also funded in part by the CardioVascular Research Foundation and Edwards Lifesciences. The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Dr Yeung has received institutional research support from Edwards Lifesciences. Dr Fearon has received institutional research support from Edwards Lifesciences. Dr Malaisrie has received consulting fees from Edwards Lifesciences, Medtronic, CryoLife, and Terumo Aortc. Dr D.-W. Park received research grants, consulting, and speaker fees from Edwards Lifesciences, Medtronic, Abbott, and Daiichi-Sankyo during the conduct of this study. Dr S.-J. Park received grants from Edwards Lifesciences, Medtronic, and Abbott during the conduct of the study. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Keywords

TAVR
aortic valve stenosis
mortality
outcomes

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jcin.2021.08.038

Cite this

Park, H., Ahn, J. M., Kang, D. Y., Kim, J. B., Yeung, A. C., Nishi, T., Fearon, W. F., Cantey, E. P., Flaherty, J. D., Davidson, C. J., Malaisrie, S. C., Kim, S., Yun, S. C., Ko, E., Lee, S. A., Kim, D. H., Kim, H. J., Kim, J. B., Choo, S. J., ... Park, S. J. (2021). Racial Differences in the Incidence and Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement. JACC: Cardiovascular Interventions, 14(24), 2670-2681. https://doi.org/10.1016/j.jcin.2021.08.038

@article{b5fe7fefc05545e094f4679026090691,

title = "Racial Differences in the Incidence and Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement",

abstract = "Objectives: The aim of this study was to compare the incidence and prognostic significance of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) according to racial groups. Background: PPM after TAVR may be of more concern in Asian populations considering their relatively small annular and valve sizes compared with Western populations. Methods: 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 from January 2015 to November 2019. PPM was defined as moderate (0.65-0.85 cm2/m2) or severe (<0.65 cm2/m2) at the indexed effective orifice area. The primary outcome was a composite of death, stroke, or rehospitalization at 1 year. Results: Among 1,101 eligible patients (533 Asian and 569 non-Asian), the incidence of PPM was significantly lower in the Asian population (33.6\%; moderate, 26.5\%; severe, 7.1\%) than in the non-Asian population (54.5\%; moderate, 29.8\%; severe, 24.7\%). The 1-year rate of the primary outcome was similar between the PPM and non-PPM groups (27.5\% vs 28.1\%; P = 0.69); this pattern was consistent between Asian (25.4\% vs 25.2\%; P = 0.31) and non-Asian (28.7\% vs 32.1\%; P = 0.97) patients. After multivariable adjustment, the risk for the primary outcome did not significantly differ between the PPM and non-PPM groups in the overall population (HR: 0.95; 95\% CI: 0.74-1.21), in Asian patients (HR: 1.07; 95\% CI: 0.74-1.55), and in non-Asian patients (HR: 0.86; 95\% CI: 0.63-1.19). Conclusions: In this study of patients with severe aortic stenosis who underwent TAVR, the incidence of PPM was significantly lower in Asian patients than in non-Asian patients. The 1-year risk for the primary composite outcome was similar between the PPM and non-PPM groups regardless of racial group.",

keywords = "TAVR, aortic valve stenosis, mortality, outcomes",

author = "Hanbit Park and Ahn, \{Jung Min\} and Kang, \{Do Yoon\} and Kim, \{Juyong Brian\} and Yeung, \{Alan C.\} and Takeshi Nishi and Fearon, \{William F.\} and Cantey, \{Eric Page\} and Flaherty, \{James D.\} and Davidson, \{Charles J.\} and Malaisrie, \{S. Christopher\} and Sehee Kim and Yun, \{Sung Cheol\} and Euihong Ko and Lee, \{Seung Ah\} and Kim, \{Dae Hee\} and Kim, \{Ho Jin\} and Kim, \{Joon Bum\} and Choo, \{Suk Jung\} and Park, \{Duk Woo\} and Park, \{Seung Jung\}",

note = "Funding Information: All 3 databases were standardized according to the common database model and merged in accordance with the policy of data use agreed upon among the participating centers; patient demographics, surgical risk (Society of Thoracic Surgeons Predicted Risk of Mortality score), functional status, clinical risk factors or comorbidities, anatomical or hemodynamic parameters by cardiac computed tomography or echocardiography, procedural details, and in-hospital and follow-up outcomes were collected in the common database. Each center{\textquoteright}s Institutional Review Board or ethics committee approved the protocol for the registry. TP-TAVR was partly funded by the CardioVascular Research Foundation and was supported by a grant (2020IF0016) from Asan Institute for Life Sciences and Corporate Relations of Asan Medical Center. The sponsor had no role in the study design or in the collection, analysis, or interpretation of data. Funding Information: This study was supported by grant 2020IF0016 from the Asan Institute for Life Sciences and Corporate Relations of Asan Medical Center with NAVER. This study was also funded in part by the CardioVascular Research Foundation and Edwards Lifesciences. The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Dr Yeung has received institutional research support from Edwards Lifesciences. Dr Fearon has received institutional research support from Edwards Lifesciences. Dr Malaisrie has received consulting fees from Edwards Lifesciences, Medtronic, CryoLife, and Terumo Aortc. Dr D.-W. Park received research grants, consulting, and speaker fees from Edwards Lifesciences, Medtronic, Abbott, and Daiichi-Sankyo during the conduct of this study. Dr S.-J. Park received grants from Edwards Lifesciences, Medtronic, and Abbott during the conduct of the study. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: {\textcopyright} 2021 American College of Cardiology Foundation",

year = "2021",

month = dec,

day = "27",

doi = "10.1016/j.jcin.2021.08.038",

language = "English (US)",

volume = "14",

pages = "2670--2681",

journal = "JACC: Cardiovascular Interventions",

issn = "1936-8798",

publisher = "Elsevier Inc.",

number = "24",

}

Park, H, Ahn, JM, Kang, DY, Kim, JB, Yeung, AC, Nishi, T, Fearon, WF, Cantey, EP, Flaherty, JD , Davidson, CJ , Malaisrie, SC, Kim, S, Yun, SC, Ko, E, Lee, SA, Kim, DH, Kim, HJ, Kim, JB, Choo, SJ, Park, DW & Park, SJ 2021, 'Racial Differences in the Incidence and Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement', JACC: Cardiovascular Interventions, vol. 14, no. 24, pp. 2670-2681. https://doi.org/10.1016/j.jcin.2021.08.038

TY - JOUR

T1 - Racial Differences in the Incidence and Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement

AU - Park, Hanbit

AU - Ahn, Jung Min

AU - Kang, Do Yoon

AU - Kim, Juyong Brian

AU - Yeung, Alan C.

AU - Nishi, Takeshi

AU - Fearon, William F.

AU - Cantey, Eric Page

AU - Flaherty, James D.

AU - Davidson, Charles J.

AU - Malaisrie, S. Christopher

AU - Kim, Sehee

AU - Yun, Sung Cheol

AU - Ko, Euihong

AU - Lee, Seung Ah

AU - Kim, Dae Hee

AU - Kim, Ho Jin

AU - Kim, Joon Bum

AU - Choo, Suk Jung

AU - Park, Duk Woo

AU - Park, Seung Jung

N1 - Funding Information: All 3 databases were standardized according to the common database model and merged in accordance with the policy of data use agreed upon among the participating centers; patient demographics, surgical risk (Society of Thoracic Surgeons Predicted Risk of Mortality score), functional status, clinical risk factors or comorbidities, anatomical or hemodynamic parameters by cardiac computed tomography or echocardiography, procedural details, and in-hospital and follow-up outcomes were collected in the common database. Each center’s Institutional Review Board or ethics committee approved the protocol for the registry. TP-TAVR was partly funded by the CardioVascular Research Foundation and was supported by a grant (2020IF0016) from Asan Institute for Life Sciences and Corporate Relations of Asan Medical Center. The sponsor had no role in the study design or in the collection, analysis, or interpretation of data. Funding Information: This study was supported by grant 2020IF0016 from the Asan Institute for Life Sciences and Corporate Relations of Asan Medical Center with NAVER. This study was also funded in part by the CardioVascular Research Foundation and Edwards Lifesciences. The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Dr Yeung has received institutional research support from Edwards Lifesciences. Dr Fearon has received institutional research support from Edwards Lifesciences. Dr Malaisrie has received consulting fees from Edwards Lifesciences, Medtronic, CryoLife, and Terumo Aortc. Dr D.-W. Park received research grants, consulting, and speaker fees from Edwards Lifesciences, Medtronic, Abbott, and Daiichi-Sankyo during the conduct of this study. Dr S.-J. Park received grants from Edwards Lifesciences, Medtronic, and Abbott during the conduct of the study. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: © 2021 American College of Cardiology Foundation

PY - 2021/12/27

Y1 - 2021/12/27

N2 - Objectives: The aim of this study was to compare the incidence and prognostic significance of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) according to racial groups. Background: PPM after TAVR may be of more concern in Asian populations considering their relatively small annular and valve sizes compared with Western populations. Methods: 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 from January 2015 to November 2019. PPM was defined as moderate (0.65-0.85 cm2/m2) or severe (<0.65 cm2/m2) at the indexed effective orifice area. The primary outcome was a composite of death, stroke, or rehospitalization at 1 year. Results: Among 1,101 eligible patients (533 Asian and 569 non-Asian), the incidence of PPM was significantly lower in the Asian population (33.6%; moderate, 26.5%; severe, 7.1%) than in the non-Asian population (54.5%; moderate, 29.8%; severe, 24.7%). The 1-year rate of the primary outcome was similar between the PPM and non-PPM groups (27.5% vs 28.1%; P = 0.69); this pattern was consistent between Asian (25.4% vs 25.2%; P = 0.31) and non-Asian (28.7% vs 32.1%; P = 0.97) patients. After multivariable adjustment, the risk for the primary outcome did not significantly differ between the PPM and non-PPM groups in the overall population (HR: 0.95; 95% CI: 0.74-1.21), in Asian patients (HR: 1.07; 95% CI: 0.74-1.55), and in non-Asian patients (HR: 0.86; 95% CI: 0.63-1.19). Conclusions: In this study of patients with severe aortic stenosis who underwent TAVR, the incidence of PPM was significantly lower in Asian patients than in non-Asian patients. The 1-year risk for the primary composite outcome was similar between the PPM and non-PPM groups regardless of racial group.

AB - Objectives: The aim of this study was to compare the incidence and prognostic significance of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) according to racial groups. Background: PPM after TAVR may be of more concern in Asian populations considering their relatively small annular and valve sizes compared with Western populations. Methods: 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 from January 2015 to November 2019. PPM was defined as moderate (0.65-0.85 cm2/m2) or severe (<0.65 cm2/m2) at the indexed effective orifice area. The primary outcome was a composite of death, stroke, or rehospitalization at 1 year. Results: Among 1,101 eligible patients (533 Asian and 569 non-Asian), the incidence of PPM was significantly lower in the Asian population (33.6%; moderate, 26.5%; severe, 7.1%) than in the non-Asian population (54.5%; moderate, 29.8%; severe, 24.7%). The 1-year rate of the primary outcome was similar between the PPM and non-PPM groups (27.5% vs 28.1%; P = 0.69); this pattern was consistent between Asian (25.4% vs 25.2%; P = 0.31) and non-Asian (28.7% vs 32.1%; P = 0.97) patients. After multivariable adjustment, the risk for the primary outcome did not significantly differ between the PPM and non-PPM groups in the overall population (HR: 0.95; 95% CI: 0.74-1.21), in Asian patients (HR: 1.07; 95% CI: 0.74-1.55), and in non-Asian patients (HR: 0.86; 95% CI: 0.63-1.19). Conclusions: In this study of patients with severe aortic stenosis who underwent TAVR, the incidence of PPM was significantly lower in Asian patients than in non-Asian patients. The 1-year risk for the primary composite outcome was similar between the PPM and non-PPM groups regardless of racial group.

KW - TAVR

KW - aortic valve stenosis

KW - mortality

KW - outcomes

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UR - http://www.scopus.com/inward/citedby.url?scp=85120746621&partnerID=8YFLogxK

U2 - 10.1016/j.jcin.2021.08.038

DO - 10.1016/j.jcin.2021.08.038

M3 - Article

C2 - 34838464

AN - SCOPUS:85120746621

SN - 1936-8798

VL - 14

SP - 2670

EP - 2681

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

IS - 24

ER -

Racial Differences in the Incidence and Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement

Abstract

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ASJC Scopus subject areas

UN SDGs

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