Prosthesis-Patient Mismatch in Small Aortic Annuli: Self-Expandable vs. Balloon-Expandable Transcatheter Aortic Valve...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Biomedical Engineering

Background:

• Prosthesis-patient mismatch (PPM) negatively impacts outcomes after surgical aortic valve replacement (SAVR).
• PPM is increasingly recognized in transcatheter aortic valve replacement (TAVR), especially in patients with small aortic annuli.
• Evaluating hemodynamic performance of different TAVR devices in small annuli is crucial.

Purpose of the Study:

• To compare the hemodynamic performance of balloon-expandable (BE) Sapiens 3 and self-expandable (SE) Evolut Pro and Accurate Neo TAVR devices.
• To assess device performance specifically in patients with small aortic annuli (computed tomography aortic annulus area 330–440 mm²).

Main Methods:

• A prospective study enrolled 131 consecutive patients undergoing TAVR for small aortic annuli.
• Patients received either Sapiens 3 (BE), Evolut Pro (SE), or Accurate Neo (SE) devices.
• Hemodynamic performance, including prosthesis-patient mismatch (PPM) and paravalvular leaks (PVL), was evaluated.

Main Results:

• BE devices had significantly higher rates of PPM (39.5%) compared to SE devices (15.4% for Evolut Pro, 6.9% for Accurate Neo) (p < 0.0001).
• SE devices showed higher rates of moderate-to-severe paravalvular leaks (≥ 2/4) (15.4%–17.2%) compared to BE devices (2.6%) (p = 0.007).
• Despite higher PVL, SE devices achieved superior hemodynamic results.

Conclusions:

• Self-expandable TAVR devices demonstrate better hemodynamic performance in patients with small aortic annuli.
• The increased rate of paravalvular leaks with SE devices did not negate their hemodynamic advantage.
• SE TAVI devices are recommended as a potential first choice for patients with small aortic anatomy.