# Impact of Measured and Predicted Patient–Prosthesis Mismatch on Quality of Life Following Transcatheter Aortic Valve Implantation

## TL;DR

This study finds that patient-prosthesis mismatch after heart valve implantation does not reduce quality of life improvements over one year.

## Contribution

Shows for the first time that valve mismatch severity does not affect quality of life outcomes after TAVI.

## Key findings

- TAVI significantly improved quality of life at 30 days and 1 year.
- Severe mismatch did not hinder quality of life improvements.
- Results were consistent across different mismatch types and severities.

## Abstract

While patient–prosthesis mismatch (PPM) after transcatheter aortic valve implantation (TAVI) has not been associated with increased mortality, its impact on quality of life (QoL) remains unclear.

We retrospectively analyzed 3013 patients undergoing TAVI (2012-2022) within a large health care system. Patients were stratified by effective orifice area indexed to body surface area (EOAi) into no (EOAi >0.85 cm2/m2), moderate (EOAi >0.65 cm2/m2 or ≤0.85 cm2/m2), or severe (EOAi ≤0.65 cm2/m2) PPM, with lower cutoffs for obese patients (body mass index ≥30 kg/m2).

The median age was 80.0 (73.0; 86.0) years, and 55.6% were female with a median Society of Thoracic Surgery risk score of 4.70% (2.66; 7.64). Overall, TAVI led to significant improvements in New York Heart Association and Kansas City Cardiomyopathy Questionnaire scores at 30 days and 1 year. Severe predicted and severe measured PPm was not associated with inferior QoL outcomes improvement (all p > 0.05).

In this large cohort, TAVI yielded substantial and durable QoL gains, regardless of PPM severity or valve type. These findings suggest that moderate or severe PPM does not diminish functional recovery and should not be a primary determinant in valve selection or procedural strategy at 1 year.

•Large real-world TAVR cohort with structured quality-of-life follow-up.•Quality of life improved at 30 days and 1 year after TAVR.•Improvements were consistent regardless of prosthesis–patient mismatch.•Findings held across mismatch presence, type, and severity categories.•Suggests valve mismatch has limited impact on post-TAVR quality of life.

Large real-world TAVR cohort with structured quality-of-life follow-up.

Quality of life improved at 30 days and 1 year after TAVR.

Improvements were consistent regardless of prosthesis–patient mismatch.

Findings held across mismatch presence, type, and severity categories.

Suggests valve mismatch has limited impact on post-TAVR quality of life.