Transcatheter aortic valve replacement in small aortic annuli: A propensity-matched comparison between intra-annular self-expanding valves and balloon-expandable valves.

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.