Computed Tomography-Based Indexed Aortic Annulus Size to Predict Prosthesis-Patient Mismatch.

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Prosthetic Valve Technology

Background:

• Transcatheter aortic valve replacement (TAVR) generally offers superior hemodynamic performance compared to surgical aortic valve replacement (SAVR), particularly in patients with small native annulus sizes.
• The consistency of these benefits across varying degrees of prosthesis-patient mismatch (PPM) propensity, considering patient annulus and body size, remains an area of active investigation.

Purpose of the Study:

• To compare the hemodynamic performance and clinical outcomes of TAVR versus SAVR in intermediate-risk patients stratified by indexed aortic annulus size.
• To evaluate the incidence and predictors of prosthesis-patient mismatch (PPM) in both TAVR and SAVR groups.

Main Methods:

• The study analyzed data from the SURTAVI trial, comparing self-expandable TAVR valves with SAVR in intermediate-risk patients.
• Indexed aortic annulus size was calculated using multidetector computed tomography and categorized into small, medium, and large groups.
• Hemodynamics, PPM rates, and clinical outcomes were assessed up to 1-year post-procedure.

Main Results:

• TAVR prostheses were larger with increasing indexed annulus size, unlike SAVR.
• Patients receiving TAVR demonstrated significantly better indexed effective orifice area and lower mean gradients across all annulus size groups.
• Rates of PPM were substantially lower with TAVR compared to SAVR in all groups and decreased with larger indexed annulus sizes for both procedures.

Conclusions:

• TAVR consistently provides superior hemodynamic performance and lower PPM rates than SAVR, irrespective of the patient's propensity for PPM.
• Indexed annulus size is an independent predictor of PPM for both TAVR and SAVR.
• Clinical outcomes were similar, except for a higher reintervention rate with TAVR in the large annulus group, suggesting careful consideration for procedural and valve selection.