J Cardiovasc Interv.
2023 Jul;2(3):187-198. 10.54912/jci.2023.0001.
Features and Outcomes of Small Aortic Valve Annulus Transcatheter Aortic Valve Replacement: The Korean TAVR Registry
- Affiliations
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- 1Division of Cardiology, Department of Internal Medicine, Uijeongbu Eulji University Hospital, Uijeongbu, Korea
- 2Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- 3Department of Internal Medicine, Seoul National University, Seoul, Korea
- 4Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- 5Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
- KMID: 2560945
- DOI: http://doi.org/10.54912/jci.2023.0001
Abstract
- Background
Transcatheter aortic valve replacement (TAVR) in a small annulus may cause patient prosthesis mismatch and worse outcomes but data on the outcomes of small annulus TAVR are limited.
Methods
All patients treated with TAVR between June 2015 and June 2018 at 21 TAVR centers in Korea were retrospectively analyzed. The primary outcomes were procedure-related complications and major adverse cardiac events (MACE). The secondary outcomes were aortic regurgitation, paravalvular leakage, effective orifice area index, patient prosthesis mismatch, and aortic valve pressure gradient. We compared the outcomes of: 1) small annulus and non-small annulus valves; and 2) balloon-expandable valves and self-expandable valves among patients with small annulus valves.
Results
Of the total 660 patients, 70 (10.6%) patients had a small annulus with a mean annular diameter of 18.7 mm, while the mean diameter in the non-small annulus patients was 23.4 mm. Average age was similar (78.3 vs. 78.6, P = 0.631) and small annulus group had more females (80.0% vs. 46.8%, P < 0.001). Median follow up duration was 517 days. Both groups had similar procedure-related complication rates (8.6% vs. 6.6%, P = 0.715) and similar clinical outcomes at 1 year with 10.0% and 14.4% MACE rates, respectively (P = 0.410). Balloon-expandable valves and self-expandable valves had similar complication rates (7.4% vs. 9.8%, P = 1.000) and similar 1 year MACE rates (18.5% vs. 4.9%, P = 0.161).
Conclusions
Short-term TAVR outcomes in patients with a small annulus diameter were favorable and comparable to that of patients with a larger annulus diameter. Complication rates and clinical outcomes were similar with the use of balloon-expandable valves and selfexpandable valves.
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