Key result
Small bioprosthetic valves show no difference in major events versus larger valves despite poorer hemodynamics.
Why the study?
Studies evaluating the impact of smaller body type on prosthesis-patient mismatch severity after small-sized SAVR are limited, particularly among Asian patients.
Does small bioprosthetic valve size compared to larger sizes worsen hemodynamic performance and clinical outcomes in Asian patients undergoing surgical aortic valve replacement?
Cohort (n=695)
Yes
Does small bioprosthetic valve size compared to larger sizes worsen hemodynamic performance and clinical outcomes in Asian patients undergoing surgical aortic valve replacement?
Effect estimate: aHR 0.87 (95% CI 0.57-1.33)
Absolute Event Rate: 31.4% vs 27.6%
p-value: p=0.525
In Asian patients undergoing SAVR, smaller bioprosthetic valves resulted in poorer long-term hemodynamic performance but did not increase the risk of adverse clinical events compared to larger valves.
Small valves may be acceptable in Asian SAVR despite inferior hemodynamics; leaves open durability and subgroup questions for prospective trials.
BACKGROUND: Studies of the influence of smaller body type on the severity of prosthesis-patient mismatch (PPM) after small-sized surgical aortic valve replacement (SAVR) are few, but the issue is particularly relevant for Asian patients. METHODS AND RESULTS: 695 patients who underwent SAVR with bioprosthetic valves had their hemodynamic valve performance analyzed at 3 months, 1 year, 3 years, and 5 years after operation, and clinical outcomes were assessed. The patients were stratified into 3 valve size groups: 19/21, 23, and 25/27 mm. A smaller valve was associated with higher mean pressure gradients at the 4 time points after operation (P trend <0.05). However, the 3 valve size groups demonstrated no significant differences in the risk of clinical events. At none of the time points did patients with projected PPM show increased mean pressure gradients (P>0.05), whereas patients with measured PPM did (P<0.05). Compared with patients with projected PPM, those with measured PPM demonstrated higher rates of infective endocarditis readmission (adjusted hazard ratio [aHR] 3.31, 95% confidence interval [CI] 1.06-10.39) and a higher risk of composite outcomes (aHR 1.45, 95% CI 0.95-2.22, P=0.087). CONCLUSIONS: Relative to those receiving larger valves, patients receiving small bioprosthetic valves had poorer hemodynamic performance but did not demonstrate differences in clinical events in long-term follow-up.
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Yen et al. (2023) conducted a cohort in Aortic Valve Disease requiring Aortic Valve Replacement (n=695). Small bioprosthetic valves (19/21 mm) vs. Large bioprosthetic valves (25/27 mm) was evaluated on Composite clinical outcome (all-cause death, redo AVR, infective endocarditis hospitalization, and heart failure readmission) (aHR 0.87, 95% CI 0.57-1.33, p=0.525). Patients receiving small bioprosthetic valves (19/21 mm) had poorer hemodynamic performance but showed no significant difference in composite clinical events compared to those receiving larger valves (25/27 mm) (aHR 0.87).
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