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Comparative Analysis of Device Performance and Pacemaker Implantation Rates in Supra-Anular and Intra-Anular TAVR Valves in Patients with Small Aortic Annuli
Session:
SESSÃO DE POSTERS 05 - TAVI 1
Speaker:
Mariana Caetano Coelho
Congress:
CPC 2025
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.4 Interventional Cardiology - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Mariana Caetano Coelho; Miguel Antunes; Fernando Nascimento Ferreira; Francisco Albuquerque; Miguel Figueiredo; Francisco Cardoso; António Fiarresga; Rúben Baptista Ramos; Inês Rodrigues; Rui Ferreira; Duarte Nuno Cacela
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Introduction: Transcatheter aortic valve replacement (TAVR) has evolved from a treatment for inoperable patients to the gold standard for managing severe aortic stenosis (AS) in high and intermediate-risk patients, and more recently, in low-risk patients. A small aortic annulus (SAA), common in elderly women, increases the risk of prosthesis-patient mismatch (PPM). The leaflet mounting design, whether supra-annular (SAV) or intra-annular (IAV), influences outcomes, with SAVs offering better hemodynamics. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Aim: We aimed to compare the hemodynamic and clinical performance between two SAVs (Medtronic CoreValve Evolut R, Evolut PRO, and Boston Acurate) and two IAVs (Abbott Portico and Edwards SAPIEN 3) in patients with a SAA (area ≤ 400 mm²), during a follow-up of 4.3 years.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Outcomes: Primary outcomes included device success, and hemodynamic characteristics evaluated by echocardiography, including moderate/severe paravalvular leak (PVL), residual mean gradient, and PPM. Secondary outcomes focused on permanent pacemaker implantation (PPI).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Study Population: We included 94 patients who underwent TAVR using either SAV (n = 53) or IAV (n = 41) between 2016 and 2022. The majority were women in both groups with a mean age of 79.6 ± 8.3 years and 81.1 ± 6.5 years, respectively. The cohort was well balanced, including the Society of Thoracic Surgeons mortality score, which showed no significant difference between groups (mean score 4.19 ± 0.38 vs 4.85 ± 0.67, p = 0.097), respectively.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Outcomes: No significant difference was found in residual mean gradients (14.8 ± 1.3 vs 15.3 ± 1.2, p = 0.855) or PPM rates (1.98 ± 0.16 vs 2 ± 0.23, p = 0.416). However, PPI was significantly higher in the IAV group (0 vs 10, p = 0.05). The Sapien3 valve was more stenotic than the Portico valve (maximum velocity: 2.02 ± 0.14 vs 1.77±0.07, p = 0.011; maximum gradient: 18.2 ± 2.2 vs 13.2 ± 1, p = 0.012; mean gradient: 10.1±1.3 vs 7.5±0.6, p = 0.037). No significant difference in PPM rates or pacemaker implantation was found between the two IAV valves. No differences were seen between SAVs versus Portico valves in gradients (14.9 ± 1.3 vs 13.2 ± 1, p = 0.094) or valve areas (2 ± 0.16 vs 2.2 ± 0.4, p = 0.203), but PPI was lower with Medtronic valves (0 vs 5, p = 0.011).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Conclusions: IAVs and SAVs demonstrate similar hemodynamic performance and dysfunction after 4.3 years in patients with SAA. The Portico valve in IAVs shows more favorable outcomes, while PPI rates were higher in the IAV group.</span></span></p>
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