Key result
Supra-annular and intra-annular self-expanding valves show similar 2-year survival in small aortic annuli.
Why the study?
Outcomes comparing supra-annular versus intra-annular self-expanding valves during TAVR in patients with small aortic annuli remain underexplored.
Does the use of supra-annular self-expanding valves compared with intra-annular self-expanding valves improve clinical and hemodynamic outcomes in patients with small aortic annuli undergoing TAVR?
Observational (n=583)
No
Does the use of supra-annular self-expanding valves compared with intra-annular self-expanding valves improve clinical and hemodynamic outcomes in patients with small aortic annuli undergoing TAVR?
In patients with small aortic annuli, both intra-annular and supra-annular self-expanding valves provide comparable and excellent clinical and hemodynamic outcomes, suggesting both are reasonable options.
Answers are grounded in this paper and cite their sources.
Both valve types appear reasonable options in small annuli TAVR; leaves open superiority in randomized trials.
Background: Transcatheter aortic valve replacement (TAVR) with self-expanding valves (SEVs) may have different outcomes with supra-annular valves (SAVs) or intra-annular valves (IAVs) in patients with small aortic annuli (SAA), but this topic remains underexplored. We aimed to evaluate outcomes between different SEVs, namely SAVs (CoreValve/Evolut R/PRO/PRO+/FX) vs. IAVs (Portico/Navitor). Methods: Single-center data with patients with SAA (maximum diameter <23 mm) who underwent TAVR from 2013 to 2023 with SEVs, followed by 1:1 propensity score matching (PSM). For patients with SAA, TAVR with SEV devices is safe. Conclusions: IAVs and SAVs are associated with comparable device performance in terms of hemodynamic structural and nonstructural dysfunction. Randomized data are needed to validate these findings and guide informed device selection.
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Sá et al. (2024) conducted an observational in Severe aortic stenosis with small aortic annulus (n=583). Supra-annular self-expanding valves (CoreValve/Evolut iterations) vs. Intra-annular self-expanding valves (Portico/Navitor iterations) was evaluated on All-cause death at 2 years (propensity-matched cohort) (p=0.9750). In patients with small aortic annuli, supra-annular and intra-annular self-expanding valves showed comparable device performance with no significant difference in 2-year survival.
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