TAVR in patients with small aortic annuli resulted in higher 1-year mean AV gradients (19.2 vs 9.8 mmHg, p=0.03) but similar 1-year mortality (9% vs 13%, p>0.05) compared to those without SAA.
Cohort (n=530)
No
Does TAVR in patients with small aortic annuli lead to worse echocardiographic and clinical outcomes compared to patients without small annuli?
TAVR in patients with small aortic annuli results in higher post-procedural and 1-year mean aortic gradients, but this does not translate to worse clinical outcomes or survival compared to patients with larger annuli.
Absolute Event Rate: 9% vs 13%
p-value: p=>0.05
Abstract Introduction Transcatheter aortic valve replacement (TAVR) is a key treatment for severe aortic stenosis (AS). Patients with small aortic annuli (SAA) present unique challenges, including higher risks of PVL and elevated gradients, which may reduce its hemodynamic, symptomatic, and prognostic benefits. Outcomes in this group require further study. Purpose To evaluate the echocardiographic and clinical outcomes of AS patients with SAA (defined as area ≤ 4.3 cm² by CT), submitted to TAVR. Methods Single-center, retrospective study on patients submitted to TAVR between 2017 and 2023. Clinical and echocardiographic data were collected from hospital records. Kaplan-Meier (KM) survival analysis was performed. Results A total of 530 patients were included (55% female, median age 81,9 years), of which 287 had SAA. There were no significative differences in demographic characteristics, comorbidities or baseline echocardiographic assessment between the two groups. 51% of patients received a self-expandable valve and 49% received a balloon-expandable valve. Transthoracic echocardiogram (TTE) at discharge revealed higher maximum (20.2 mmHg vs 17.2 mmHg, p0.01) and mean aortic gradients (11.3 mmHg vs 9.8 mmHg, p 0.01) for SAA, despite similar doppler velocity index (DVI) in both groups (0.6). At 1 year follow up, there was a significant higher mean AV gradient in SAA patients (19.2 mmHg vs. 9.8 mmHg, p=0.03) and similar maximum AV gradients (19.2 mmHg vs 19 mmHg, p=0.07) and DVI. There were no significant differences regarding clinical outcomes: death at 1 year (9% vs 13%, p0.05); cardiovascular hospitalization (12% in both groups, p0.05) ; stroke (4% vs 11%, p0.05); moderate to severe aortic regurgitation (2% vs 3%, p0.05) and valvular dysfunction, defined as mean AV gradient of at least 20 mmHg at 1 year (3% vs 2%, p0.05). Kaplan-Meier curve and Cox regression analysis showed similar rates of death during a mean FUP of 41± 22 months (p0.05). Conclusion TAVR in patients with SAA is associated with higher post-procedural and 1-year mean AV gradients, despite similar DVI. No significant differences in clinical outcomes were observed. Further research is needed to understand the implications of these findings and optimize TAVR outcomes in this important subgroup of patients.
Araújo et al. (Sat,) conducted a cohort in severe aortic stenosis (n=530). Transcatheter aortic valve replacement (TAVR) in small aortic annuli vs. TAVR in non-small aortic annuli was evaluated on Death at 1 year (p=>0.05). TAVR in patients with small aortic annuli resulted in higher 1-year mean AV gradients (19.2 vs 9.8 mmHg, p=0.03) but similar 1-year mortality (9% vs 13%, p>0.05) compared to those without SAA.