Patients with a small aortic annulus undergoing TAVI had a higher incidence of death, stroke, or heart failure hospitalization compared with the SMART trial self-expanding valve cohort (21% vs 9.4%).
Cohort (n=300)
No
Does TAVI in real-world patients with a small aortic annulus result in different rates of adverse outcomes compared to the SMART trial self-expanding valve cohort?
Real-world patients with small aortic annuli undergoing TAVI have higher rates of adverse outcomes compared to clinical trial cohorts, likely driven by older age, higher surgical risk, and comorbidities such as atrial fibrillation and impaired renal function.
Absolute Event Rate: 21% vs 9.4%
Abstract Introduction Transcatheter aortic valve implantation (TAVI) has transformed the management of severe aortic stenosis (AS). However, anatomical factors such as a small aortic annulus (SAA) remain key determinants of procedural and clinical outcomes. Purpose This study aimed to characterise patients with SAA undergoing TAVI, compare their outcomes with those of the self-expanding valve (SEV) cohort from the SMART trial, and identify predictors of adverse events. Methods We retrospectively analysed patients who underwent TAVI between 2021 and 2024 at a tertiary care centre. SAA was defined as an aortic annulus area (AAA) 4.3 cm² on computed tomography (CT). Demographic, echocardiographic, and CT parameters were recorded. The composite outcome included all-cause death, stroke, or heart failure hospitalisation (HFh). Results Among 300 patients, 55% (n = 166) had SAA. This group was predominantly female (80.7%, n = 134), with a mean age of 83 ± 5 years and mean Society of Thoracic Surgeons (STS) score 5.8 ± 5.2%. Baseline characteristics of our cohort and the SMART trial SEV group are presented in Figure 1. Median aortic gradient was 50.4 ± 13.6 mmHg, maximum velocity 4.5 ± 0.57 m/s, aortic valve area 0.71 ± 0.21 cm², and AAA 3.6 ± 0.47 cm². SEV was implanted in 98% of procedures. Over a mean follow-up of 599 ± 339 days, the composite outcome occurred in 21.7% (death 10.8%, stroke 5.4%, HFh 6.0%). Compared with the SMART trial SEV cohort, the incidence of the composite outcome was higher (21% vs 9.4%), as were the individual components: death (10.8% vs 5.1%), stroke (5.4% vs 3.1%), and HFh (6.0% vs 3.8%). Univariate analysis showed associations between the composite outcome and atrial fibrillation (AF; 44% vs 13.5%, p 0.001), previous myocardial infarction (MI; 13.9% vs 3.9%, p = 0.028), glomerular filtration rate (GFR) 30 mL/min/1.73 m² (33.3% vs 6.3%, p 0.001), and higher STS scores (8.5 vs 5.4%, p = 0.028). Multivariate analysis identified AF and reduced GFR as independent predictors. Conclusion Patients with SAA undergoing TAVI exhibited a higher incidence of adverse outcomes compared with the SMART trial SEV cohort. Differences in baseline characteristics, including older age, higher STS scores, and smaller annular size, may account for these results. AF and impaired renal function independently predicted the composite outcome.
Silva et al. (Fri,) conducted a cohort in Severe aortic stenosis with small aortic annulus (n=300). Transcatheter aortic valve implantation (TAVI) vs. SMART trial self-expanding valve (SEV) cohort was evaluated on Composite of all-cause death, stroke, or heart failure hospitalisation. Patients with a small aortic annulus undergoing TAVI had a higher incidence of death, stroke, or heart failure hospitalization compared with the SMART trial self-expanding valve cohort (21% vs 9.4%).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: