EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2025
Intra- versus supra-annular self-expanding transcatheter heart valves in small aortic annuli.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Yamamoto Masanori, Ryuzaki Toshinobu, Hioki Hirofumi, Kagase Ai, Shirai Shinichi, Ohno Yohei, Yashima Fumiaki, Naganuma Toru, Yamawaki Masahiro, Watanabe Yusuke, Yamanaka Futoshi, Mizutani Kazuki, Noguchi Masahiko, Izumo Masaki, Takagi Kensuke, Asami Masahiko, Ueno Hiroshi, Nishina Hidetaka, Suzuyama Hiroto, Yamasaki Kazumasa, Nishioka Kenji, Hachinohe Daisuke, Fuku Yasushi, Otsuka Toshiaki, Hayashida Kentaro, Ocean-Tavi Investigators On Behalf Of The
Аннотация
BACKGROUND: Clinical data are scarce comparing supra-annular self-expanding valves (SA-SEVs) and intra-annular (IA)-SEVs after transcatheter aortic valve implantation (TAVI), particularly in patients with a small aortic annulus (SAA).
AIMS: We aimed to compare early clinical outcomes, including echocardiographic parameters, between the latest generation of IA-SEV and SA-SEV after TAVI in patients with SAA.
METHODS: Focused on patients with SAA, defined as an annulus area ≤430 mm2, the data of 919 patients who underwent TAVI with an IA-SEV (n=518, Navitor) or an SA-SEV (n=401, Evolut FX) were retrospectively extracted. Differences in valve design on postprocedural results were investigated between the two groups and in the propensity score-matched (PSM) cohort.
RESULTS: The postprocedural effective orifice area (EOA), indexed EOA, and mean pressure gradient (mPG) were similar in the overall cohort between the two groups (allp>0.05), whereas the mPG was higher with IA-SEVs than with SA-SEVs (8.74±5.01 mmHg vs 7.84±4.43 mmHg; p=0.049) after PSM (n=219 patients/group). There were no significant differences in the incidence of severe prosthesis-patient mismatch (1.9% vs 0.9%; p=0.405) or paravalvular leakage ≥mild (34.1% vs 42.2%; p=0.084) between the 2 groups in the PSM cohort. The rates of technical success (95.9% vs 95.8%), device success at discharge (91.3% vs 87.8%), and in-hospital death (1.4% vs 0.5%) were comparable in the overall cohort (allp>0.05). These results were not changed in the PSM cohort (allp>0.05).
CONCLUSIONS: The latest-generation IA-SEV and SA-SEV demonstrated similar clinical results except for a few echocardiographic findings after TAVI in patients with SAA.
AIMS: We aimed to compare early clinical outcomes, including echocardiographic parameters, between the latest generation of IA-SEV and SA-SEV after TAVI in patients with SAA.
METHODS: Focused on patients with SAA, defined as an annulus area ≤430 mm2, the data of 919 patients who underwent TAVI with an IA-SEV (n=518, Navitor) or an SA-SEV (n=401, Evolut FX) were retrospectively extracted. Differences in valve design on postprocedural results were investigated between the two groups and in the propensity score-matched (PSM) cohort.
RESULTS: The postprocedural effective orifice area (EOA), indexed EOA, and mean pressure gradient (mPG) were similar in the overall cohort between the two groups (allp>0.05), whereas the mPG was higher with IA-SEVs than with SA-SEVs (8.74±5.01 mmHg vs 7.84±4.43 mmHg; p=0.049) after PSM (n=219 patients/group). There were no significant differences in the incidence of severe prosthesis-patient mismatch (1.9% vs 0.9%; p=0.405) or paravalvular leakage ≥mild (34.1% vs 42.2%; p=0.084) between the 2 groups in the PSM cohort. The rates of technical success (95.9% vs 95.8%), device success at discharge (91.3% vs 87.8%), and in-hospital death (1.4% vs 0.5%) were comparable in the overall cohort (allp>0.05). These results were not changed in the PSM cohort (allp>0.05).
CONCLUSIONS: The latest-generation IA-SEV and SA-SEV demonstrated similar clinical results except for a few echocardiographic findings after TAVI in patients with SAA.