Key result
Intra-annular self-expanding TAVR in small annuli yields a mean post-procedural gradient of ~9 mmHg.
Why the study?
TAVI carries a higher risk for elevated trans-prosthetic gradients and prosthesis-patient mismatch in patients with a small aortic annulus.
Does transcatheter aortic valve implantation with self-expanding intra-annular valves provide favorable hemodynamic performance in patients with small aortic annuli?
Cohort (n=37)
No
Does transcatheter aortic valve implantation with self-expanding intra-annular valves provide favorable hemodynamic performance in patients with small aortic annuli?
Self-expanding transcatheter aortic valves with an intra-annular leaflet position demonstrate favorable short-term hemodynamic performance and low gradients in patients with small aortic annuli.
Favorable short-term hemodynamics seen with intra-annular self-expanding valves in small annuli; leaves open comparative outcomes versus other designs.
Background and Objectives: Transcatheter aortic valve implantation is associated with a higher risk for elevated trans-prosthetic gradients and prosthesis-patient mismatch in patients with a small aortic annulus. We aimed to assess the short-term hemodynamic performance of self-expanding transcatheter aortic valves with an intra-annular leaflet position in patients with small aortic anatomies. Materials and Methods: Consecutive patients with small aortic annuli (annular area < 430 mm2), who underwent transcatheter aortic valve implantation with a self-expanding Portico or Navitor (Abbott Medical, St. Paul, MN, USA) transcatheter aortic valve between October 2017 and August 2024 at the University Medical Centre Ljubljana, Slovenia, were analyzed. The main endpoints were the post-procedural mean trans-prosthetic gradient, the presence of moderate or severe prosthesis-patient mismatch or paravalvular regurgitation. Results: Overall, 37 patients were included in the study (29 patients with a native aortic valve and 8 patients undergoing valve-in-valve transcatheter aortic valve implantation). The mean age was 81.6 ± 4.3 years, 32 patients (86.5%) were female. The median annular perimeter was 70.8 mm (interquartile range 67.3–74.1 mm) and the median annular area was 379 mm2 (interquartile range 355–412 mm2). The post-procedural mean trans-prosthetic gradient was 9.0 ± 3.5 mmHg, with no cases with a mean gradient > 20 mmHg. Moderate and severe prosthesis-patient mismatch was observed in 21.2% and 3.0% of patients, respectively. Mild paravalvular regurgitation was noted in 44.1% of patients, there were no cases of moderate or severe paravalvular regurgitation. One patient (3.0%) had moderate valvular regurgitation. Conclusions: Self-expanding transcatheter aortic valves with an intra-annular leaflet position are associated with favorable hemodynamic performance in patients with a small aortic annulus.
No takes yet. Share an insight, caveat, or question.
Bunc et al. (2025) conducted a cohort in Small aortic annulus (n=37). Self-expanding transcatheter aortic valves with an intra-annular leaflet position (Portico or Navitor) was evaluated on Post-procedural mean trans-prosthetic gradient, presence of moderate or severe prosthesis-patient mismatch or paravalvular regurgitation. Self-expanding transcatheter aortic valves with an intra-annular leaflet position in small aortic annuli yielded a post-procedural mean trans-prosthetic gradient of 9.0 mmHg and 3.0% severe PPM.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: