Transcatheter Aortic Valve Replacement in Patients With Small Aortic Annulus: An Observational Study.

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Biomaterials Science

Background:

• Small aortic annuli (SAA) present unique challenges for transcatheter aortic valve replacement (TAVR).
• Previous trials indicated superior hemodynamics with self-expanding valves (SEVs) compared to balloon-expandable valves (BEVs) in SAA patients.
• Long-term clinical implications of these hemodynamic disparities remain unclear.

Purpose of the Study:

• To compare the long-term clinical outcomes of SEVs versus BEVs in patients with SAA undergoing TAVR.
• To investigate the impact of patient-prosthesis mismatch (PPM) on mortality in this population.

Main Methods:

• An observational cohort study included 258 SAA patients (annular area ≤430 mm²) undergoing TAVR with BEV or SEV.
• Exclusion criteria included valve-in-valve procedures and alternative access.
• Patient-prosthesis mismatch (PPM) was defined by indexed effective orifice area; primary outcomes were mortality and major adverse cardiovascular events.

Main Results:

• SEVs demonstrated significantly lower mean gradients and peak velocities at 30 days post-TAVR compared to BEVs.
• The incidence of PPM was substantially lower with SEVs (18%) versus BEVs (42%).
• At 3 years, overall mortality was similar between SEV (23%) and BEV (22%) groups, with no significant association between PPM and long-term mortality.

Conclusions:

• Despite early hemodynamic advantages and reduced PPM with SEVs in SAA patients, no significant difference in 3-year mortality was observed compared to BEVs.
• These findings suggest that early hemodynamic differences may not significantly impact long-term survival in this specific patient cohort.
• Further research is warranted to fully elucidate the long-term clinical implications of valve choice in SAA patients.