Comparing Clinical Outcomes of Patients With a Small Versus Large Annulus After Newer-Generation Balloon-Expandable...

Limited data are available comparing clinical outcomes between patients with small and large annuli following transcatheter aortic valve replacement using balloon-expandable valves. This study sought to investigate 5-year clinical outcomes in patients with severe aortic stenosis with a small annulus compared with those with a large annulus following transcatheter aortic valve replacement with newer-generation balloon-expandable valves.

A total of 3182 patients with aortic stenosis treated with balloon-expandable valves were divided into small-annulus (≤430 mm²) and large-annulus (>430 mm²) groups. A 1:1 propensity-matched analysis was performed to adjust baseline differences. The primary end point was all-cause death at 5-year follow-up. Secondary end points included heart failure hospitalization, bioprosthetic valve failure, and aortic valve reintervention.

Among 533 matched pairs, compared with the large-annulus group, the small-annulus group had higher rates of aortic valve mean gradients ≥20 mm Hg (14.1% versus 2.9%; P<0.001) and severe prosthesis-patient mismatch (9.8% versus 5.2%; P=0.019). At 5 years, there were no significant differences in all-cause death (hazard ratio, 0.75 [95% CI, 0.52-1.09]; P=0.13). The incidence of heart failure rehospitalization, bioprosthetic valve failure, and aortic valve reintervention were similar between groups. Both groups achieved similar sustained improvements in New York Heart Association functional class and Kansas City Cardiomyopathy Questionnaire-Overall Summary scores.

Despite higher transvalvular gradients and a greater rate of severe prosthesis-patient mismatch, 5-year clinical outcomes in patients with a small annulus were comparable to those with a large annulus following transcatheter aortic valve replacement using newer-generation balloon-expandable valves.