The following is a summary of “Improved hemodynamics with self-expanding compared to balloon expandable transcatheter aortic valve implantation in small annulus patients: A Propensity-matched analysis,” published in the April 2024 issue of Cardiology by Baudo et al.
Prosthesis-patient mismatch (PPM) can occur in patients with small aortic annuli (SAA) when trying for aortic valve replacement.
Researchers conducted a retrospective study comparing clinical and hemodynamic outcomes of self-expandable Valves (SEV) vs. balloon-expandable valves (BEV) in transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis and SAA.
They included patients who underwent TAVI for severe native aortic stenosis with SAA between January 2018 and December 2022. The propensity score matched balanced baseline characteristics. Bioprosthesis valve dysfunction was assessed by modified Valve Academic Research Consortium 3 (VARC-3) criteria.
The results showed that among 1,170 TAVI procedures performed between 2018 and 2022, 332 patients had SAA, with 109 balanced pairs after exclusion and matching. BEV showed higher mean transvalvular gradients (P<0.001), higher mitral regurgitation (P=0.029), and lower ejection fraction at discharge (P<0.043). The SEV group had significantly fewer BVD events (P=0.002) at follow-up, particularly severe PPM (P=0.046) and structural valve deterioration (P=0.040).
Investigators concluded that BEV TAVI in patients with SAA had higher mean pressure gradients and more PPM than SEV. While the mortality rates did not differ, SEV showed better outcomes regarding valve function, warranting future research.
Source: ajconline.org/article/S0002-9149(24)00264-9/abstract
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