Transcatheter aortic valve implantation in patients with extra-small aortic annuli.
Journal
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
ISSN: 1969-6213
Titre abrégé: EuroIntervention
Pays: France
ID NLM: 101251040
Informations de publication
Date de publication:
17 Jul 2023
17 Jul 2023
Historique:
pmc-release:
17
07
2024
medline:
18
7
2023
pubmed:
19
6
2023
entrez:
19
6
2023
Statut:
epublish
Résumé
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. The aim of this study was to analyse the safety and efficacy of TAVI in patients with extra-SAA. A multicentre registry study including patients with extra-SAA (defined as an aortic annulus area <280 mm 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. 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.
Sections du résumé
BACKGROUND
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
OBJECTIVE
The aim of this study was to analyse the safety and efficacy of TAVI in patients with extra-SAA.
METHODS
METHODS
A multicentre registry study including patients with extra-SAA (defined as an aortic annulus area <280 mm
RESULTS
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
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.
Identifiants
pubmed: 37334654
pii: EIJ-D-23-00011
doi: 10.4244/EIJ-D-23-00011
pmc: PMC10333922
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e340-e351Références
Thorac Cardiovasc Surg. 2014 Sep;62(6):469-74
pubmed: 24554597
Circ Cardiovasc Interv. 2014 Oct;7(5):701-11
pubmed: 25270901
Am J Cardiol. 2020 Mar 15;125(6):956-963
pubmed: 31948662
Front Cardiovasc Med. 2020 Mar 20;7:38
pubmed: 32266292
Ann Thorac Surg. 2018 Apr;105(4):1129-1136
pubmed: 29307456
Front Cardiovasc Med. 2022 Mar 30;9:761917
pubmed: 35433878
Lancet. 2020 Sep 5;396(10252):669-683
pubmed: 32593323
J Clin Med. 2022 Apr 01;11(7):
pubmed: 35407567
Int J Cardiol. 2017 Aug 1;240:126-131
pubmed: 28606674
JACC Cardiovasc Interv. 2018 Apr 23;11(8):771-780
pubmed: 29673509
J Heart Valve Dis. 1996 Nov;5 Suppl 3:S284-8
pubmed: 8953455
JACC Cardiovasc Interv. 2021 Jul 12;14(13):1466-1477
pubmed: 34238557
Circulation. 2017 Sep 12;136(11):1049-1069
pubmed: 28893961
Int J Cardiol. 2013 Oct 3;168(3):2658-64
pubmed: 23587400
Circulation. 2021 Feb 2;143(5):e72-e227
pubmed: 33332150
Heart Lung Circ. 2018 Feb;27(2):227-234
pubmed: 28473216
EuroIntervention. 2019 Mar 20;14(16):1648-1655
pubmed: 30418159
Catheter Cardiovasc Interv. 2021 May 1;97(6):E875-E886
pubmed: 32926552
Clin Res Cardiol. 2021 Dec;110(12):1957-1966
pubmed: 34387736
JACC Cardiovasc Interv. 2020 Jan 27;13(2):196-206
pubmed: 31883714
Circulation. 2019 Jun 4;139(23):2685-2702
pubmed: 31157994
JACC Cardiovasc Interv. 2018 Dec 24;11(24):2507-2518
pubmed: 30503595
J Cardiovasc Comput Tomogr. 2014 Jan-Feb;8(1):67-76
pubmed: 24582045
Ann Thorac Surg. 2018 Jul;106(1):14-22
pubmed: 29630873
Korean Circ J. 2021 Mar;51(3):222-231
pubmed: 33655721
Eur J Cardiothorac Surg. 2022 Jun 15;62(1):
pubmed: 35298609
Am J Cardiol. 2017 Mar 15;119(6):900-904
pubmed: 28109558
Eur J Cardiothorac Surg. 2011 Aug;40(2):441-7
pubmed: 21236693
Lancet. 2019 Nov 2;394(10209):1619-1628
pubmed: 31570258
Circ Cardiovasc Interv. 2017 Oct;10(10):
pubmed: 28951395
JACC Cardiovasc Interv. 2015 Jan;8(1 Pt A):1-9
pubmed: 25616813
EuroIntervention. 2022 Feb 04;17(14):e1126-e1196
pubmed: 34931612
JACC Cardiovasc Interv. 2016 Feb 8;9(3):244-254
pubmed: 26847116
Int J Cardiovasc Imaging. 2019 May;35(5):827-836
pubmed: 30661140
JACC Cardiovasc Imaging. 2020 Jan;13(1 Pt 1):124-139
pubmed: 31103575
Front Cardiovasc Med. 2021 Apr 21;8:658016
pubmed: 33969021
JACC Cardiovasc Interv. 2021 Jun 14;14(11):1218-1228
pubmed: 34112458
Ann Thorac Surg. 2008 Jan;85(1):94-100
pubmed: 18154789