Key result
A small aortic annulus was associated with similar mortality and heart failure rehospitalization compared to a large annulus post-TAVR across all flow-gradient patterns (e.g., classical LFLG AS HR 0.93; 95% CI 0.51-1.69).
Why the study?
Patients with small annuli risk worse post-TAVR hemodynamics, but whether a small annulus confers worse clinical outcomes across AS flow-gradient patterns remains debatable.
Does a small aortic annulus compared to a large annulus affect mortality and heart failure rehospitalization in patients undergoing balloon-expandable TAVR across different flow-gradient patterns?
Cohort (n=1,866)
Does a small aortic annulus compared to a large annulus affect mortality and heart failure rehospitalization in patients undergoing balloon-expandable TAVR across different flow-gradient patterns?
Hazard Ratio: 0.93 (95% CI 0.51–1.69)
Patients with small and large aortic annuli have similar intermediate-term clinical outcomes following balloon-expandable TAVR across all flow-gradient patterns, despite small annuli being associated with worse hemodynamic performance and higher rates of structural valve deterioration.
Small-annulus patients show similar clinical outcomes to large-annulus patients after balloon-expandable TAVR; observational data leave open confirmation across flow-gradient subtypes.
Background: Patients with small annuli are at risk for worse hemodynamic performance after transcatheter aortic valve replacement (TAVR). It is debatable whether a small annulus confers worse outcomes. This study explored the clinical outcomes following TAVR for patients with small and large annuli across flow-gradient subgroups of aortic stenosis (AS). Methods: ). Patients undergoing TAVR with self-expanding valves and those with annular sizing using transesophageal echocardiography were excluded. Each group was subclassified into classical low-flow low-gradient (LFLG) AS, paradoxical LFLG AS, normal-flow low-gradient AS, and high-gradient AS. Clinical outcomes included mortality and heart failure rehospitalization. Results: The study included 1866 patients, of which 709 (38%) had small annuli. There was no difference in heart failure rehospitalization and mortality between the groups in any of the 4 flow-gradient patterns: hazard ratio (HR) = 0.93 (95% confidence interval [CI]: 0.51-1.69) for patients with classical LFLG AS, HR = 0.95, CI (0.62-1.47) for patients with paradoxical LFLG AS, HR = 1.16, CI (0.49-2.74) for patients with normal-flow low-gradient AS, and HR = 0.73, CI (0.50-1.07) for patients with high-gradient AS, using large annulus as a reference. Patients with small annuli had higher mean gradients, lower dimensionless valve index, and a higher incidence of hypoattenuated leaflet thickening and structural valve deterioration post-TAVR. Conclusions: Patients with small and large annuli have similar intermediate-term clinical outcomes post-TAVR across all flow-gradient patterns treated with balloon-expandable valve.
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Besir et al. (2025) conducted a cohort in Aortic stenosis (n=1,866). Small aortic annulus vs. Large aortic annulus was evaluated on Mortality and heart failure rehospitalization (HR 0.93, 95% CI 0.51-1.69). A small aortic annulus was associated with similar mortality and heart failure rehospitalization compared to a large annulus post-TAVR across all flow-gradient patterns (e.g., classical LFLG AS HR 0.93; 95% CI 0.51-1.69).
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