RT @JACCJournals: M-TEER effectively 📉 MR to ≤1+ & 📈 symptoms in both aSMR & vSMR. Particularly in aSMR, ≥moderate baseline TR is linked to….

RT @TCTMD: Registry Data Rekindle Talk Over the Best Valve for TAVI in Small Annuli

What do you want to know?.

Our recent work on BEV vs. SEV in small annuli has been covered by @TCTMD_Caitlin on @TCTMD, commented by #SMART PI #HowardCHerrmann. @HenningGuthoff.

#IMPPACT TAVR investigators @Mo_A_W @TRheude @dmylotte @SebLudwig1 @philipppvstein @tk_rudolph @MachereyMeyer @AbdullahAlabcha @CurioJonathan @Drroxmehran @didier_tchetche @GilbertTangMD.

Our take: mortality after TAVR appears to be driven primarily by baseline comorbidities. Valve selection should consider patient-specific valvular anatomy, conduction disturbances, procedural feasibility, and lifetime management considerations rather than hemodynamics alone.

In 5817 patients with small aortic annulus undergoing #TAVR, 3-year all-cause mortality was 23.0 vs. 24.0% in BEV vs. SEV treated patients. Valve type was not an independent predictor of 3-year mortality in multivariable analysis including age, sex, LVEF, CKD, and AF.

Do the hemodynamic advantages of SEV vs BEV as seen in #SMART translate into superior clinical outcomes in patients with small aortic annulus? . A new analysis by @HenningGuthoff out of the #IMPPACT TAVR registry just published in @JACCJournals.#JACCInt .

@guilbon @PCRonline @RobinWeinrank @CurioJonathan.

IMPPACT TAVI investigators @Mo_A_W @bara_doc @HWienemann @JaSham10 @VerenaVeulemans @barbanti_marco @jury_schewel @TRheude @G_Tarantini01 @SabineBleiziff2 @dmylotte @SebLudwig1 @CardioSchmidt @AndreasRck2 @philippvstein @thiele_holger @MattiAdam_MD @tk_rudolph @MachereyMeyer.

Thank you so much @AbdullahAlabcha for the opportunity to share my key takes on measured vs. predicted Prosthesis-Patient-Mismatch #PPM after #TAVR from the #IMPPACT_TAVI registry. Out now in @JACCJournals.#JACCInt.

@guilbon @CurioJonathan @TernacleJ @PCRonline @AbdullahAlabcha.

IMPPACT TAVI investigators @Mo_A_W @bara_doc @HWienemann @JaSham10 @VerenaVeulemans @barbanti_marco @jury_schewel @TRheude @G_Tarantini01 @SabineBleiziff2 @dmylotte @SebLudwig1 @CardioSchmidt @AndreasRck2 @philippvstein @thiele_holger @MattiAdam_MD @tk_rudolph @MachereyMeyer.

Summarized, despite the theoretical advantages of PPMp, the concept is unable to predict adverse outcomes after TAVR and is biased towards patients with inherently better survival. PPMm is merely a marker of adverse outcomes after TAVR than an independent causal factor. (8/8).

🎯PPMm is associated with worse and PPMp with better survival after TAVR in unadjusted analysis.🎯After adjustment for comorbidities, no significant impact on two-year all-cause mortality was observed for any type of PPM, neither predicted nor measured.(7/8).

🎯 PPMm and PPMp identify different patient populations: .- PPMm is associated with male sex, AF, lower LVEF.- PPMp is associated with female sex and smaller annulus. The correlation between the 2 is negligible.(6/8).

The IMPPACT TAVI registry investigated the prevalence and impact on outcomes of PPMp and PPMm in >38 000 patients from 26 centers. Key results:.🎯The prevalence of PPMp is significantly lower than that of PPMm.(5/8).

In the surgical literature, PPMp has been applied and shown to be associated with adverse outcomes. In contrast, TAVR studies mostly used PPMm with conflicting results. It is unclear whether PPMp is a useful concept in TAVR patients (4/8).

PPM can be defined in 2 ways:.- measured PPM (PPMm): a patient's individual EOA is determined by echo through the continuity equation.- predicted PPM (PPMp): a reference EOA value of a certain valve derived from comprehensive studies is used and normalized to a patient's BSA(3/8).

PPM is a condition where the effective orifice area (EOA) of a prosthetic valve is too small in relation to the patient's individual body surface area despite normal valve function. PPM has been associated with adverse outcome after SAVR, while data after TAVR is conflicting(2/8).

A tale of measured and predicted prosthesis-patient-mismatch #PPM after #TAVR - an analysis of the #IMPPACT TAVI registry by @HenningGuthoff just published in @JACCJournals #JACCInt, accompanied by an editorial of the godfather of PPM @PPibarot . 🧵(1/8)