Prosthesis-patient mismatch following transcatheter aortic valve replacement for degenerated transcatheter aortic valves: the TRANSIT-PPM international project

Luca Testa, Matteo Casenghi, Enrico Criscione, Nicolas M. Van Mieghem, Didier Tchétché, Anita W. Asgar, Ole De Backer, Azeem Latib, Bernhard Reimers, Giulio Stefanini, Carlo Trani, Francesco Giannini, Antonio Bartorelli, Wojtek Wojakowski, Maciej Dabrowski, Dariusz Jagielak, Adrian P. Banning, Rajesh Kharbanda, Raul Moreno, Joachim SchoferChristina Brinkmann, Niels van Royen, Duane Pinto, Antoni Serra, Amit Segev, Arturo Giordano, Nedy Brambilla, Mauro Agnifili, Antonio Popolo Rubbio, Mattia Squillace, Jacopo Oreglia, Rudolph Tanja, James M. McCabe, Alexander Abizaid, Michiel Voskuil, Rui Teles, Giuseppe Biondi Zoccai, Lars Sondergaard, Francesco Bedogni

Research output: Contribution to journalArticlepeer-review


Background: A severe prosthesis-patient mismatch (PPM) is associated with adverse outcomes following transcatheter aortic valve replacement (TAVR) for de novo aortic stenosis or a failed surgical bioprosthesis. The impact of severe PPM in patients undergoing TAV-in-TAVR is unknown. Aim: We sought to investigate the incidence and 1-year outcomes of different grades of PPM in patients undergoing TAV-in-TAVR. Materials and methods: The TRANSIT-PPM is an international registry, including cases of degenerated TAVR treated with a second TAVR. PPM severity, as well as in-hospital, 30-day, and 1-year outcomes were defined according to the Valve Academic Research Consortium-3 (VARC-3) criteria. Results: Among 28 centers, 155 patients were included. Severe PPM was found in 6.5% of patients, whereas moderate PPM was found in 14.2% of patients. The rate of severe PPM was higher in patients who underwent TAV-in-TAVR with a second supra-annular self-expanding (S-SE) TAVR (10%, p = 0.04). Specifically, the rate of severe PPM was significantly higher among cases of a SE TAVR implanted into a balloon-expandable (BE) device (19%, p = 0.003). At 1-year follow-up, the rate of all-cause mortality, and the rate of patients in the New York Heart Association (NYHA) class III/IV were significantly higher in the cohort of patients with severe PPM (p = 0.016 and p = 0.0001, respectively). Almost all the patients with a severe PPM after the first TAVR had a failed < 23 mm BE transcatheter heart valve (THV): the treatment with an S-SE resolved the severe PPM in the majority of the cases. Conclusion: After TAV-in-TAVR, in a fifth of the cases, a moderate or severe PPM occurred. A severe PPM is associated with an increased 1-year all-cause mortality. Clinical trial registration: [], identifier [NCT04500964].

Original languageEnglish (US)
Article number931207
JournalFrontiers in Cardiovascular Medicine
StatePublished - Jul 29 2022
Externally publishedYes


  • TAVR
  • TAVR in TAVR
  • failed TAVR
  • mortality
  • prosthesis-patient mismatch

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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