Aortic annulus size did not significantly impact 30-day mortality (P=0.153) or MACE (P=0.675) in patients undergoing TAVI, though smaller sizes were associated with more bleeding events (P=0.016).
Cohort (n=342)
No
Does aortic annulus size impact short-term mortality and major adverse cardiovascular events in patients undergoing TAVI?
Aortic annulus size does not significantly impact 30-day mortality or overall MACE in TAVI patients, though smaller annulus sizes are associated with increased puncture site bleeding.
p-value: p=0.153 for mortality, 0.675 for MACE
Abstract Background Transcatheter aortic valve intervention (TAVI) is an established treatment modality for severe aortic stenosis (AS) in older and high-risk patients (1). Accurate preoperative sizing of aortic annulus (AA) is important for appropriate transcatheter aortic valve (TAV) selection and avoidance of periprocedural complications (2,3). Aim The aim of our study was to determine whether the size of aortic annulus in TAVI patients is associated with short-term (30 days) mortality and major adverse cardiovascular events (MACE) which included bleeding, stroke, total atrioventricular (AV) block requiring permanent pacemaker implantation and significant paravalvular leak (PVL). Methods We included patients who underwent TAVI in our institution from July 2021 to January 2025. All patients underwent preoperative transthoracic echocardiogram (TTE) to evaluate severity of AS, its haemodynamic effects, and AA size. Computed tomographic angiography (CTA) was used to confirm dimensions of AA. We classified patients into small (400 mm2), intermediate (400-575 mm2) and large (≥575 mm2) AA group, respectively. We followed up patients in ambulatory controls or by telephone calls. Results This registry-based study included 342 patients undergoing TAVI with a median age of 80 years (IQR 76-84), 50% female, with mean Vmax 4.38m/s (±0.676), mean MPG 48mmHg (±18.442) and mean AVA 0.89 cm2 (±2.438). Total of 81 patients had small, 217 intermediate and 44 large AA. There were no differences regarding the baseline characteristics between the 3 groups, except there were significantly more female in small AA group, and patients with large AA had significantly lower left ventricular ejection fraction (EFLV) and higher perioperative risk scores (Table 1). After TAVI, reduction in Vmax (mean change –2.239m/s, SD ± 0.965, p=0.943) and MPG (mean change -36.2mmHg, SD ± 19.78, p=0.634) was comparable between the groups, however there was statistically significant improvement in AVA in small AA group compared to large AA group (Table 2). During short-term follow up, there was no significant difference regarding mortality (6 vs. 3 vs. 0 deaths, p=0.153) or MACE (31 vs. 75 vs. 6 in small, intermediate and large AA group, p=0.675) between the 3 groups. Most common MACE was total AV block, developing in 35.7% of all adverse events (AE), followed by PVL which occurred in 27.7% of all AE, bleeding at the site of puncture (23.2%) and stroke (12.5%). There were statistically more bleeding events in small and intermediate AA group vs. large AA group (p=0.016). Conclusion Valvular annulus size did not impact short-term outcomes in TAVI patients. There were more bleeding events at the site of puncture in patients with small and intermediate AA size.Table 1:Baseline characteristics Table 2:Outcomes after TAVI procedure
Varga et al. (Thu,) conducted a cohort in Severe aortic stenosis (n=342). Aortic annulus size vs. Different annulus sizes (small, intermediate, large) was evaluated on Short-term (30 days) mortality and major adverse cardiovascular events (MACE) (p=0.153 for mortality, 0.675 for MACE). Aortic annulus size did not significantly impact 30-day mortality (P=0.153) or MACE (P=0.675) in patients undergoing TAVI, though smaller sizes were associated with more bleeding events (P=0.016).