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Addressing Small Annulus in TAVR: Procedural Success and Clinical Outcomes
Session:
SESSÃO DE POSTERS 34 - TAVI 2
Speaker:
Miguel Azaredo Raposo
Congress:
CPC 2025
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Miguel Azaredo Raposo; Ana Abrantes; Catarina Gregório; Daniel Cazeiro; João Cravo; Marta Vilela; Diogo Ferreira; Cláudia Jorge; Miguel Nobre Menezes; João Silva Marques; Pedro Carrilho Ferreira; Fausto J. Pinto
Abstract
<p><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="color:black">Introduction</span></span></strong></span></span></span></p> <div> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">Transcatheter aortic valve replacement (TAVR) is a key treatment for severe aortic stenosis (AS). Patients with small aortic annuli (SAA) present unique challenges, including higher risks of PVL and elevated gradients, which may reduce its hemodynamic, symptomatic, and prognostic benefits. Outcomes in this group require further study. </span></span></span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="color:black">Purpose</span></span></strong></span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">To evaluate the echocardiographic and clinical outcomes of AS patients with SAA (defined as area ≤ 4.3 cm² by CT), submitted to TAVR.</span></span></span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="color:black">Methods</span></span></strong></span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">Single-center, retrospective study on patients submitted to TAVR between 2017 and 2023. Clinical and echocardiographic data were collected from hospital records. Kaplan-Meier (KM) survival analysis was performed.</span></span></span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="color:black">Results</span></span></strong></span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">A total of 530 patients were included (55% female, median age 81,9 years), of which 287 had SAA. There were no significative differences in demographic characteristics, comorbidities or baseline echocardiographic assessment between the two groups. 51% of patients received a self-expandable valve and 49% received a balloon-expandable valve. Transthoracic echocardiogram (TTE) at discharge revealed higher maximum (20.2 mmHg vs 17.2 mmHg, p<0.01) and mean aortic gradients (11.3 mmHg vs 9.8 mmHg, p< 0.01) for SAA, despite similar doppler velocity index (DVI) in both groups (0.6). At 1 year follow up, there was a significant higher mean AV gradient in SAA patients (19.2 mmHg vs. 9.8 mmHg, p=0.03) and similar maximum AV gradients (19.2 mmHg vs 19 mmHg, p=0.07) and DVI. There were no significant differences regarding clinical outcomes: death at 1 year (9% vs 13% p=NS); cardiovascular hospitalization (12% in both groups) ; stroke (4% vs 11% p=NS); moderate to severe aortic regurgitation (2% vs 3% p=NS) and valvular dysfunction, defined as mean AV gradient of at least 20 mmHg at 1 year (3% vs 2% p=NS). Kaplan-Meier curve and Cox regression analysis showed similar rates of death during a mean FUP of 41± 22 months (p=NS)</span></span></span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="color:black">Conclusion</span></span></strong></span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">TAVR in patients with SAA is associated with higher post-procedural and 1-year mean AV gradients, despite similar DVI. No significant differences in clinical outcomes were observed.</span></span> <span style="font-size:11pt"><span style="color:black">Further research is needed to understand the implications of these findings and optimize TAVR outcomes in this important subgroup of patients submitted to TAVR.</span></span></span></span></span></p> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div id="accel-snackbar" style="left:50%; top:50px; transform:translate(-50%, 0px)"> </div>
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