Key result
Small aortic annulus linked to ~84% higher risk of prosthesis-patient mismatch after TAVR.
Why the study?
The details and consequences of a small aortic annulus among TAVR patients remain uncertain, including comparative outcomes between intra- and supra-annular devices.
Does an intra-annular device improve 30-day hemodynamic outcomes compared to a supra-annular device in TAVR patients with a small annulus?
Observational (n=5,870)
Yes
Does an intra-annular device improve 30-day hemodynamic outcomes compared to a supra-annular device in TAVR patients with a small annulus?
Odds Ratio: 1.84 (95% CI 1.46–2.32)
Absolute Event Rate: 18.2% vs 13.1%
p-value: p=<0.001
In TAVR patients with a small annulus, supra-annular devices provide better short-term echocardiographic and hemodynamic improvement compared to intra-annular devices, without increasing paravalvular leakage.
Device selection may influence gradients in small-annulus TAVR; observational data leaves open optimal choice pending randomized trials.
BACKGROUND: The details and consequences of a small aortic annulus among transcatheter aortic valve replacement (TAVR) patients remain uncertain. This study investigated the short-term outcomes in patients with small annular size and compared the 30-day outcome between intra- and supra-annular devices, with similar outer casing diameter in this subgroup. METHODS AND RESULTS: [0.8-1.24], P=0.001) and higher mPG (14.0 mmHg [10.0-18.5] vs. 11.0 [7.0-14.0], P<0.001) compared with those receiving a 23-mm supra-annular device, although the incidence of paravalvular leakage (≥moderate) was similar (14.4% vs. 16.5%, P=0.69). CONCLUSIONS: Patients with a small annulus were associated with less hemodynamic improvement. A supra-annular device is associated with better echocardiographic improvement in patients with a small annulus, without increasing paravalvular leakage.
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A 2021 study conducted an observational in Aortic stenosis (n=5,870). Small aortic annulus (area ≤314 mm2) vs. Normal-sized aortic annulus (>314 mm2) was evaluated on Prosthesis-patient mismatch (PPM) within 30 days (OR 1.84, 95% CI 1.46-2.32, p=<0.001). A small aortic annulus was significantly associated with an increased risk of prosthesis-patient mismatch within 30 days after transcatheter aortic valve replacement compared to a normal-sized annulus (OR 1.84).
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