Transcatheter aortic valve implantation in small surgical aortic prosthesis for small body size patients.

BackgroundValve-in-valve transcatheter aortic valve implantation (TAVI) has been confirmed as effective. Additionally, aortic annular enlargement has been advocated to avoid small valves at initial surgery, because they can cause patient-prosthesis mismatch, particularly after TAVI in surgical aortic valve replacement (SAVR). However, results remain unclear for TAVI with a small initial aortic valve in small body size patients. The purpose is to clarify the TAVI valve function after a small surgical valve in a small body population.MethodsWe retrospectively screened 52 cases of TAVI in SAVR performed from 2018 to 2024. Post-procedural TAVI valve function and post-procedural New York Heart Association (NYHA) functional class were examined.ResultsOf 52 TAVI in SAVR cases, 16 cases had a 19 mm initial surgical aortic valve, and 19 cases had 21 mm. The mean age of these 35 cases was 83.1 years old and 20% were male. Mean body surface area was 1.39 cm2. After TAVI in SAVR in 35 cases, the mean pressure gradient was 18.5 mmHg, and the effective orifice area (EOA) was 1.10 cm2. Even after 19-mm SAVR, the mean pressure gradient was 13.4 mmHg, and EOA was 1.13 cm2, excluding 3 cases of off-label use and 3 cases of balloon-expandable valves. At the time of last follow-up, 86.2% of survivors remained in NYHA I or II.ConclusionsSelf-expanding TAVI in a certain type of SAVR provided sufficient valve function in a population with small body size, even after small-sized initial surgical prostheses. Surgeons need to ensure that the proper type and size of surgical prosthesis are implanted.