Late Clinical Outcomes of Balloon-Expandable Valves in Small Annuli

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2025-02-24 DOI:10.1016/j.jcin.2024.11.006

Rebecca T. Hahn MD , Philippe Pibarot DVM, PhD , Amr Abbas MD , Raj Makkar MD , Vinod H. Thourani MD , Philippe Généreux MD , Susheel Kodali MD , Samir Kapadia MD , Vasilis Babaliaros MD , Julien Ternacle MD, PhD , Alexis Theron MD, PhD , Nicole Cristell MD , Sarah Clarke DNP , Yanglu Zhao MD, PhD , Maria Alu MS , Mahesh V. Madhavan MD, MS , David J. Cohen MD, MSc , Jonathon Leipsic MD , John Webb MD , Michael J. Mack MD , Martin B. Leon MD

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引用次数: 0

Abstract

Background

Short-term clinical outcomes after transcatheter aortic valve replacement (TAVR) are similar in individuals with small or large annuli. The longer term impact of prosthesis-patient mismatch (PPM) and mean gradient (MG) post-TAVR in these patients remains controversial.

Objectives

The aim of this study was to investigate 5-year outcomes in patients with small vs large annuli.

Methods

Patients from the PARTNER (Placement of Aortic Transcatheter Valves) 2 SAPIEN 3 intermediate-risk registry and the PARTNER 3 low-risk randomized controlled trial were grouped according to small (≤430 mm²) or large (>430 mm²) annular size. The primary endpoint was a composite of all-cause death, disabling stroke, or heart failure hospitalization. In addition, the relationships between both PPM and post-TAVR MG and clinical outcomes were analyzed.

Results

In total, 1,355 patients were included: 476 with small annuli (376.7 ± 41.9 mm²) and 879 with large annuli (518.3 ± 58.0 mm²). Patients with small annuli were older (age 79.6 ± 7.1 years vs 78.7 ± 7.8 years; P = 0.047), were more often female (75.0% vs 16.2%; P < 0.0001), had higher baseline Society of Thoracic Surgeons scores (4.3% ± 1.93% vs 4.0% ± 1.93%; P < 0.0001), and had higher left ventricular ejection fractions (66.3% ± 15.82% vs 59.7% ± 13.68%; P < 0.0001). Primary endpoint rates were similar at 1 year (7.8% vs 8.0%; P = 0.94) and 5 years (36.3% vs 35.8%; P = 0.83). Bioprosthetic valve failure was infrequent at 5 years in both groups (2.9% vs 2.1%; P = 0.46). Among female patients, outcomes were similar for small vs large annuli (primary endpoint; 33.6% vs 34.2%; P = 0.90). Among patients with small annuli, there was no association between 5-year outcomes and any severity of PPM (P = 0.22) or 30-day MG (P for nonlinearity = 0.96).

Conclusions

Five-year clinical outcomes were excellent and comparable between patients with small vs large aortic annuli. Outcomes in patients with small annuli were not affected by 30-day MG or PPM.

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来源期刊

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.