Key result
20-mm SAPIEN 3 valve is feasible in small annuli with MACE comparable to larger valves.
Why the study?
Few reports have focused on outcomes for SAPIEN 3 20-mm transcatheter heart valve implantation, which is associated with a higher incidence of prosthesis-patient mismatch than larger valve sizes.
Does 20-mm balloon-expandable transcatheter heart valve implantation compared to 23- or 26-mm valves affect the composite of cardiovascular death, nonfatal MI, nonfatal stroke, heart failure hospitalization, and reintervention in patients with severe aortic stenosis and a small aortic annulus?
Observational (n=43)
No
Does 20-mm balloon-expandable transcatheter heart valve implantation compared to 23- or 26-mm valves affect the composite of cardiovascular death, nonfatal MI, nonfatal stroke, heart failure hospitalization, and reintervention in patients with severe aortic stenosis and a small aortic annulus?
Absolute Event Rate: 0% vs 11%
p-value: p=0.14
Implantation of a 20-mm balloon-expandable transcatheter heart valve in patients with a small aortic annulus is feasible and not associated with severe prosthesis-patient mismatch or increased short-term adverse events compared to larger valve sizes.
Supports 20-mm SAPIEN 3 use without excess events in small annuli; leaves open randomized confirmation versus larger valves.
Objective: Transcatheter aortic valve implantation (TAVI) is an effective therapeutic procedure for treating severe aortic valve stenosis (AS) in inoperable or high-risk surgical patients. Prosthesis–patient mismatch (PPM) after TAVI or surgical aortic valve replacement (SAVR) is a critical determinant for mortality and morbidity related to the procedure. TAVI could be advantageous over SAVR regarding the reduction of risks of PPM. However, few reports have focused on outcomes for SAPIEN 3 20-mm transcatheter heart valve (THV) implantation, which is associated with higher incidence of PPM than a larger size of THV. This study aimed to compare pre- and post-procedural hemodynamic and clinical data including PPM between 20-mm and 23- or 26-mm SAPIEN 3 THVs, taking into an account for the feasibility of smaller size of THV.
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Sugiyama et al. (2021) conducted an observational in Severe aortic valve stenosis (n=43). SAPIEN 3 transcatheter heart valve vs. 23- or 26-mm SAPIEN 3 THV was evaluated on Composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, hospitalization due to heart failure, and reintervention for implanted valve failure (p=0.14). Implantation of the 20-mm SAPIEN 3 transcatheter heart valve in patients with a small aortic annulus was feasible, with no major adverse cardiovascular events observed compared to 11% in the 23- or 26-mm group (p=0.14).
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