Cardiovascular revascularization medicine : including molecular interventions · 2025
Transcatheter aortic valve replacement in small aortic annuli: A propensity-matched comparison between intra-annular self-expanding valves and balloon-expandable valves.
СтатьяНаблюдательное исследованиеСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Ahmad Danial, Sá Michel Pompeu, Kliner Dustin, Serna-Gallegos Derek, Toma Catalin, Makani Amber, West David, Wang Yisi, Thoma Floyd, Ogami Takuya, Hasan Irsa, Sultan Ibrahim
Аннотация
BACKGROUND: Specific transcatheter aortic valve replacement (TAVR) valve superiority is not established in the small aortic annulus (SAA) population. We sought to compare clinical and echocardiographic characteristics between patients with a SAA who underwent TAVR with either intra-annular self-expanding valves (SEV) or balloon-expandable valves (BEV).
METHODS: This was an observational, retrospective analysis (2013-2023). SAA was defined as an aortic annulus diameter < 23 mm (maximum) and annulus area ≤ 430 mm2. Unmatched and propensity-score matched (PSM) populations were compared.
RESULTS: We identified 663 patients with SAA who underwent TAVR with SEV (n = 106) or BEV (n = 557). The PSM cohort (96 pairs) was predominantly female (90.6 % and 87.5 %) with a median age of 82.5 and 81.0 years. No statistically significant differences were observed in VARC-3 outcomes (periprocedural mortality, technical success, device success, clinical efficacy). Higher rates of residual mean gradients >20 mmHg were seen in the BEV group at 30 days (SEV 2.1 % vs BEV 21.9 %, P < 0.001) as well as lower median values of indexed effective orifice area (SEV 0.9 vs 0.6 cm2/m2). Severe PPM was also more common in the BEV group (SEV 5.2 % vs BEV 21.9 %, P = 0.002). At 2 years, differences in the rates of all-cause death (SE 11.9 % vs BE 17.1 %, Plog-rank = 0.6794) and stroke (SEV 3.4 % vs BEV 10.2 %, P = 0.7055) were not statistically significant.
CONCLUSIONS: Intra-annular SEV presented better hemodynamics compared to BEV; however, survival and incidence of stroke were comparable between the groups at 2 years. Potential risk of nonstructural valve deterioration with BEV needs further investigation with longer follow-up.
METHODS: This was an observational, retrospective analysis (2013-2023). SAA was defined as an aortic annulus diameter < 23 mm (maximum) and annulus area ≤ 430 mm2. Unmatched and propensity-score matched (PSM) populations were compared.
RESULTS: We identified 663 patients with SAA who underwent TAVR with SEV (n = 106) or BEV (n = 557). The PSM cohort (96 pairs) was predominantly female (90.6 % and 87.5 %) with a median age of 82.5 and 81.0 years. No statistically significant differences were observed in VARC-3 outcomes (periprocedural mortality, technical success, device success, clinical efficacy). Higher rates of residual mean gradients >20 mmHg were seen in the BEV group at 30 days (SEV 2.1 % vs BEV 21.9 %, P < 0.001) as well as lower median values of indexed effective orifice area (SEV 0.9 vs 0.6 cm2/m2). Severe PPM was also more common in the BEV group (SEV 5.2 % vs BEV 21.9 %, P = 0.002). At 2 years, differences in the rates of all-cause death (SE 11.9 % vs BE 17.1 %, Plog-rank = 0.6794) and stroke (SEV 3.4 % vs BEV 10.2 %, P = 0.7055) were not statistically significant.
CONCLUSIONS: Intra-annular SEV presented better hemodynamics compared to BEV; however, survival and incidence of stroke were comparable between the groups at 2 years. Potential risk of nonstructural valve deterioration with BEV needs further investigation with longer follow-up.