Patients with small aortic annulus (<430 mm²) had higher early safety events (aOR 2.78) but lower 5-year mortality (aHR 0.37) after TAVR compared to non-SAA patients.
Does small aortic annulus area (<430 mm²) affect early safety and long-term clinical outcomes in patients undergoing TAVR?
In a Southeast Asian TAVR registry, patients with small aortic annuli experienced worse early safety outcomes but paradoxically better 5-year survival compared to those with larger annuli.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Patients with small aortic annuli (SAA), defined as an annular area 430 mm²(1) on computed tomography, are at increased risk of adverse outcomes following transcatheter aortic valve replacement (TAVR)(2,3). However, long-term clinical efficacy and survival outcomes in this group remain unclear, particularly in Southeast Asian populations. This study evaluates the impact of SAA on early safety and long-term outcomes in patients undergoing TAVR. Methods This was a retrospective study involving 295 patients who underwent TAVR from 2010 to 2023. Patients were stratified into SAA (430 mm²) and non-SAA (≥430 mm²) groups. Baseline demographics, echocardiographic parameters and clinical outcomes were compared. Early safety composite endpoint included all-cause mortality, stroke, major bleed, vascular complications, structural complications, stage 3/4 acute kidney injury (AKI), and new permanent pacemaker implantation. Clinical efficacy composite endpoint included all-cause mortality, stroke and cardiovascular hospitalisations. Multivariable binomial logistic regression was used to assess composite endpoints predictors of composite endpoints, while Cox proportional hazards models and Kaplan-Meier analysis were applied to assess 1-year and 5-year mortality. Results Patients with SAA were predominantly female (71.6% vs. 24.1%, p0.001) and had a smaller body surface area (BSA) (1.6 + 0.2 vs. 1.7 + 0.2, p0.001). Mean aortic annulus area is 372.0+/-40.4mm2 in SAA group vs. 507.0+/-69.1mm2 in non-SAA group. SAA group experienced higher odds of early safety events (aOR 2.78, 95% CI 1.13–7.15, p=0.024) compared to non-SAA group. There is no significant difference in long-term clinical efficacy between the two groups (aOR 0.71, 95% CI 0.37–1.36, p=0.308). While 1-year mortality was not significantly different between groups (aHR 0.37, 95% CI 0.07 – 1.84, p=0.198), SAA group experienced lower 5 year-mortality ((aHR 0.37, 95% CI 0.14–0.97, p=0.034) compared to non-SAA group. Conclusions Patients with SAA undergoing TAVR experience poorer short-term outcomes for early MACE but demonstrate better mid-term outcomes at 5-years.
Ong et al. (Sat,) reported a other. Patients with small aortic annulus (<430 mm²) had higher early safety events (aOR 2.78) but lower 5-year mortality (aHR 0.37) after TAVR compared to non-SAA patients.