Transcatheter aortic valve implantation in patients with extra-small aortic annuli
Gabriela Tirado‐Conte, Josep Rodés‐Cabau, Juan F. Oteo, Manuel Pan, Érika Muñoz, Guy Witberg, Asim N. Cheema, Alberto Alpieri, Diego Lopez, Ignacio J. Amat‐Santos, Mariama Akodad, Soledad Ojeda, Vicenc Serra, Sergio García‐Blas, Fernándo Alfonso, Ole De Backer, Lluís Asmarats, Antonio José Jiménez Muñoz, Ashraf Hamdan, Stefan Toggweiler, Raquel del Valle, Luisa Salido Tahoces, Ignacio Cruz‐González, Rodrigo Estévez‐Loureiro, Luis Enrique Martin Alfaro, Livia Gheorge, Maciec Dabrowski, Alberto Berenguer, Dabit Arzamendi, Francesco Saia, John G. Webb, Lars Søndergaard, Luis Nombela‐Franco
Abstract
BACKGROUND: A small aortic annulus (SAA) is a risk factor for prosthesis-patient mismatch (PPM) in patients undergoing surgical or transcatheter aortic valve implantation (TAVI). Data regarding TAVI in patients with extra-SAA are scarce. AIMS: The aim of this study was to analyse the safety and efficacy of TAVI in patients with extra-SAA. METHODS: and/or perimeter <60 mm) undergoing TAVI was established. Primary efficacy and safety endpoints were defined as device success and early safety at 30 days, respectively, using the Valve Academic Research Consortium-3 criteria, and were analysed according to valve type: self-expanding (SEV) versus balloon-expandable (BEV). RESULTS: A total of 150 patients were included, of which 139 (92.7%) were women, and 110 (73.3%) received an SEV. Intraprocedural technical success was 91.3%, with a higher rate in patients receiving an SEV (96.4% vs 77.5% with BEV; p=0.001). Overall, 30-day device success was 81.3%, (85.5% with SEV vs 70.0% with BEV; p=0.032). The primary safety endpoint occurred in 72.0% of patients (with no difference between groups; p=0.118). Severe PPM occurred in 12% (9.0% with SEV and 24.0% with BEV; p=0.039), with no impact on all-cause mortality, cardiovascular mortality, or heart failure readmission at 2-year follow-up. CONCLUSIONS: TAVI is a safe and feasible treatment in patients with extra-SAA with a high rate of technical success. The use of SEV was associated with a lower rate of intraprocedural complications, higher device success at 30 days and better haemodynamic outcomes compared to BEV.