Transcatheter aortic valve implantation in patients with extra-small aortic annuli

• Published in: EuroIntervention Vol. 19; no. 4; pp. e340 - e351
• Main Authors: Tirado-Conte, Gabriela, Rodés-Cabau, Josep, Oteo, Juan F, Pan, Manuel, Muñoz, Erika, Witberg, Guy, Cheema, Asim N, Alpieri, Alberto, Lopez, Diego, Amat-Santos, Ignacio J, Akodad, Mariama, Ojeda, Soledad, Serra, Vicenc, Garcia-Blas, Sergio, Alfonso, Fernando, De Backer, Ole, Asmarats, Luis, Muñoz, Antonio, Hamdan, Ashraf, Toggweiler, Stefan, Del Valle, Raquel, Salido, Luisa, Cruz-González, Ignacio, Estevez-Loureiro, Rodrigo, Martin Alfaro, Luis Enrique, Gheorge, Livia, Dabrowski, Maciec, Berenguer, Alberto, Arzamendi, Dabit, Saia, Francesco, Webb, John G, Sondergaard, Lars, Nombela-Franco, Luis
• Format: Journal Article
• Language: English
• Published: France Europa Edition 17-07-2023
• Subjects: Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Stenosis - surgery; Clinical Research; Degenerative Valve; Elderly (>75 Years); Female; Heart Valve Prosthesis; Humans; Male; Prosthesis Design; Risk Factors; Tavi; Transcatheter Aortic Valve Replacement - adverse effects; Treatment Outcome
• ISSN: 1774-024X; 1969-6213
• DOI: 10.4244/EIJ-D-23-00011

A small aortic annulus (SAA) is a risk factor for prosthesis-patient mismatch (PPM) in patients undergoing surgical or transcatheter aortic valve implantation (TAVI). Data regarding TAVI in patients with extra-SAA are scarce.
The aim of this study was to analyse the safety and efficacy of TAVI in patients with extra-SAA.
A multicentre registry study including patients with extra-SAA (defined as an aortic annulus area <280 mm
and/or perimeter <60 mm) undergoing TAVI was established. Primary efficacy and safety endpoints were defined as device success and early safety at 30 days, respectively, using the Valve Academic Research Consortium-3 criteria, and were analysed according to valve type: self-expanding (SEV) versus balloon-expandable (BEV).
A total of 150 patients were included, of which 139 (92.7%) were women, and 110 (73.3%) received an SEV. Intraprocedural technical success was 91.3%, with a higher rate in patients receiving an SEV (96.4% vs 77.5% with BEV; p=0.001). Overall, 30-day device success was 81.3%, (85.5% with SEV vs 70.0% with BEV; p=0.032). The primary safety endpoint occurred in 72.0% of patients (with no difference between groups; p=0.118). Severe PPM occurred in 12% (9.0% with SEV and 24.0% with BEV; p=0.039), with no impact on all-cause mortality, cardiovascular mortality, or heart failure readmission at 2-year follow-up.
TAVI is a safe and feasible treatment in patients with extra-SAA with a high rate of technical success. The use of SEV was associated with a lower rate of intraprocedural complications, higher device success at 30 days and better haemodynamic outcomes compared to BEV.