The presence of small annuli, defined in this registry as < 23 mm diameter or indexed diameter <12 mm/m2 by CT, continues to be one of the greatest challenges of both surgical and endovascular aortic valve treatments.
The FRANCE-TAVI Registry looked at 1,195 patients presenting small annuli. 895 (74.9%) received balloon expandable valves (BEV) and 300 self-expanding valves (SEV).
After adjusting with propensity score, due to population mismatch, 696 BEV and 232 SEV patients were matched.
Primary end point was permanent pacemaker implantation moderate to severe PPMI at one year.
Mean age was 82 and EuroScore was 4.5. Ejection fraction was 60%.
The most frequent approach was femoral (close to 90%), there were no differences in predilution or in valve diameter.
In hospital complications were low and with no differences, but the need for pacemaker implantation was higher in the SEV group (9.3% vs. 18.3% p=0.003).
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Primary end point resulted in favor of SEV, severe PPMI 8% vs. 3.5% (p=<0.001 and PPMI moderate or severe 38.5% vs. 15.6% p<0.001).
Mean gradient and valve area at one year were also in favor of SEV, 13.8 mmHg, vs 8.5 mmHg p=<0.001 and 1.1 cm2/m2 vs 0.9 cm2/m2.
At 3 years, mortality was higher in PPMI patients, as was the presence of atrial fibrillation.
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The authors have concluded that SEV presented lower PPMI rate and better hemodynamic profile, in addition to PPMI being associated to higher mortality.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Original Title: Transcatheter Aortic Valve Replacement in Small Aortic Annuli: Results From the FRANCE-TAVI Registry. Walid Ben-Al.
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