Simple Index for Identifying Patients at Increased Risk of Suboptimal Forward-Flow Hemodynamics After Transcatheter...

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Medical Imaging

Background:

• Severe aortic stenosis management requires consideration of aortic annulus size and its impact on patient outcomes.
• A small aortic annulus may present different challenges in transcatheter aortic valve replacement (TAVR) based on body size.
• The aortic annular area (AAA) index, derived from CT scans and normalized by body surface area, is a novel metric for assessing annulus size.

Purpose of the Study:

• To compare forward-flow hemodynamics and clinical outcomes after TAVR in patients with small aortic annuli.
• To evaluate the utility of the AAA index in stratifying risk in this patient population.

Main Methods:

• An international, retrospective, observational cohort study (TAVI-SMALL 2) included patients with severe aortic stenosis and small annuli.
• Propensity score matching was used to compare patients with low (≤2 cm²/m²) and high (>2 cm²/m²) AAA index.
• Primary endpoints included predischarge device forward-flow composite and 1-year clinical efficacy composite.

Main Results:

• In the propensity score-matched cohort (n=688), the predischarge forward-flow composite endpoint was more frequent in the low AAA index group (9.7%) compared to the high AAA index group (5.3%, P=0.034).
• No significant difference was observed in the 1-year clinical efficacy composite endpoint between the low and high AAA index groups (11.5% vs. 14.4%, Plog-rank=0.842).

Conclusions:

• The AAA index can identify patients with small aortic annuli at higher risk for predischarge suboptimal forward-flow hemodynamics post-TAVR.
• Despite hemodynamic differences, the AAA index did not predict clinical efficacy at 1-year follow-up in patients undergoing TAVR for small aortic annuli.