Supra-Annular Versus Intra-Annular Self-Expanding Valves in Small Aortic Annulus: A Propensity Score-Matched Study
Background: Transcatheter aortic valve replacement (TAVR) with self-expanding valves (SEVs) may have different outcomes with supra-annular valves (SAVs) or intra-annular valves (IAVs) in patients with small aortic annuli (SAA), but this topic remains underexplored. We aimed to evaluate outcomes betw...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-01-01
|
| Series: | Structural Heart |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2474870624000824 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1823861173124071424 |
|---|---|
| author | Michel Pompeu Sá, MD, MSc, MHBA, PhD Danial Ahmad, MD, MPH Yisi Wang, MPH Floyd Thoma, BS Amber Makani, MD Dustin Kliner, MD Catalin Toma, MD David West, MD Derek Serna-Gallegos, MD Ibrahim Sultan, MD |
| author_facet | Michel Pompeu Sá, MD, MSc, MHBA, PhD Danial Ahmad, MD, MPH Yisi Wang, MPH Floyd Thoma, BS Amber Makani, MD Dustin Kliner, MD Catalin Toma, MD David West, MD Derek Serna-Gallegos, MD Ibrahim Sultan, MD |
| author_sort | Michel Pompeu Sá, MD, MSc, MHBA, PhD |
| collection | DOAJ |
| description | Background: Transcatheter aortic valve replacement (TAVR) with self-expanding valves (SEVs) may have different outcomes with supra-annular valves (SAVs) or intra-annular valves (IAVs) in patients with small aortic annuli (SAA), but this topic remains underexplored. We aimed to evaluate outcomes between different SEVs, namely SAVs (CoreValve/Evolut R/PRO/PRO+/FX) vs. IAVs (Portico/Navitor). Methods: Single-center data with patients with SAA (maximum diameter <23 mm) who underwent TAVR from 2013 to 2023 with SEVs, followed by 1:1 propensity score matching (PSM). Results: We obtained 86 PSM pairs with median age of 83.0 years (SAVs) and 82.0 years (IAVs), with women representing 77.6% of the PSM cohort. After TAVR, we did not find statistically significant differences for the following outcomes: Valve Academic Research Consortium-3 periprocedural mortality, technical success, device success, clinical efficacy, and rates of paravalvular leak were not statistically significantly different, but we found higher rates of permanent pacemaker implantation in the IAV group (1.2 vs. 8.1%; p = 0.029). Despite the larger indexed effective orifice area with SAVs (median 1.0 vs. 0.8 cm2/m2, p = 0.001), we did not find statistically significant differences between the groups in terms of residual mean gradients >20 mmHg (0.0 vs. 2.3%, p = 0.155), and severe prosthesis-patient mismatch (2.3 vs. 5.8%, p = 0.390). No statistically significant difference was observed in survival (log-rank p = 0.950) and stroke (p = 0.6547) between patients who received SAVs and IAVs. For patients with SAA, TAVR with SEV devices is safe. Conclusions: IAVs and SAVs are associated with comparable device performance in terms of hemodynamic structural and nonstructural dysfunction. Randomized data are needed to validate these findings and guide informed device selection. |
| format | Article |
| id | doaj-art-41da92a5932a44e098bc03bb425eea03 |
| institution | Kabale University |
| issn | 2474-8706 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Structural Heart |
| spelling | doaj-art-41da92a5932a44e098bc03bb425eea032025-02-10T04:34:40ZengElsevierStructural Heart2474-87062025-01-0191100334Supra-Annular Versus Intra-Annular Self-Expanding Valves in Small Aortic Annulus: A Propensity Score-Matched StudyMichel Pompeu Sá, MD, MSc, MHBA, PhD0Danial Ahmad, MD, MPH1Yisi Wang, MPH2Floyd Thoma, BS3Amber Makani, MD4Dustin Kliner, MD5Catalin Toma, MD6David West, MD7Derek Serna-Gallegos, MD8Ibrahim Sultan, MD9Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Address correspondence to: Michel Pompeu Sá, MD, MSc, MHBA, PhD, UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213.Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USAUPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USAUPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USAUPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Department of Interventional Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USAUPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Department of Interventional Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USAUPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Department of Interventional Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USADepartment of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USADepartment of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USADepartment of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USABackground: Transcatheter aortic valve replacement (TAVR) with self-expanding valves (SEVs) may have different outcomes with supra-annular valves (SAVs) or intra-annular valves (IAVs) in patients with small aortic annuli (SAA), but this topic remains underexplored. We aimed to evaluate outcomes between different SEVs, namely SAVs (CoreValve/Evolut R/PRO/PRO+/FX) vs. IAVs (Portico/Navitor). Methods: Single-center data with patients with SAA (maximum diameter <23 mm) who underwent TAVR from 2013 to 2023 with SEVs, followed by 1:1 propensity score matching (PSM). Results: We obtained 86 PSM pairs with median age of 83.0 years (SAVs) and 82.0 years (IAVs), with women representing 77.6% of the PSM cohort. After TAVR, we did not find statistically significant differences for the following outcomes: Valve Academic Research Consortium-3 periprocedural mortality, technical success, device success, clinical efficacy, and rates of paravalvular leak were not statistically significantly different, but we found higher rates of permanent pacemaker implantation in the IAV group (1.2 vs. 8.1%; p = 0.029). Despite the larger indexed effective orifice area with SAVs (median 1.0 vs. 0.8 cm2/m2, p = 0.001), we did not find statistically significant differences between the groups in terms of residual mean gradients >20 mmHg (0.0 vs. 2.3%, p = 0.155), and severe prosthesis-patient mismatch (2.3 vs. 5.8%, p = 0.390). No statistically significant difference was observed in survival (log-rank p = 0.950) and stroke (p = 0.6547) between patients who received SAVs and IAVs. For patients with SAA, TAVR with SEV devices is safe. Conclusions: IAVs and SAVs are associated with comparable device performance in terms of hemodynamic structural and nonstructural dysfunction. Randomized data are needed to validate these findings and guide informed device selection.http://www.sciencedirect.com/science/article/pii/S2474870624000824Aortic valve diseaseAortic valve replacementAortic valve stenosisCardiac surgical proceduresCardiovascular surgical proceduresHeart valve diseases |
| spellingShingle | Michel Pompeu Sá, MD, MSc, MHBA, PhD Danial Ahmad, MD, MPH Yisi Wang, MPH Floyd Thoma, BS Amber Makani, MD Dustin Kliner, MD Catalin Toma, MD David West, MD Derek Serna-Gallegos, MD Ibrahim Sultan, MD Supra-Annular Versus Intra-Annular Self-Expanding Valves in Small Aortic Annulus: A Propensity Score-Matched Study Structural Heart Aortic valve disease Aortic valve replacement Aortic valve stenosis Cardiac surgical procedures Cardiovascular surgical procedures Heart valve diseases |
| title | Supra-Annular Versus Intra-Annular Self-Expanding Valves in Small Aortic Annulus: A Propensity Score-Matched Study |
| title_full | Supra-Annular Versus Intra-Annular Self-Expanding Valves in Small Aortic Annulus: A Propensity Score-Matched Study |
| title_fullStr | Supra-Annular Versus Intra-Annular Self-Expanding Valves in Small Aortic Annulus: A Propensity Score-Matched Study |
| title_full_unstemmed | Supra-Annular Versus Intra-Annular Self-Expanding Valves in Small Aortic Annulus: A Propensity Score-Matched Study |
| title_short | Supra-Annular Versus Intra-Annular Self-Expanding Valves in Small Aortic Annulus: A Propensity Score-Matched Study |
| title_sort | supra annular versus intra annular self expanding valves in small aortic annulus a propensity score matched study |
| topic | Aortic valve disease Aortic valve replacement Aortic valve stenosis Cardiac surgical procedures Cardiovascular surgical procedures Heart valve diseases |
| url | http://www.sciencedirect.com/science/article/pii/S2474870624000824 |
| work_keys_str_mv | AT michelpompeusamdmscmhbaphd supraannularversusintraannularselfexpandingvalvesinsmallaorticannulusapropensityscorematchedstudy AT danialahmadmdmph supraannularversusintraannularselfexpandingvalvesinsmallaorticannulusapropensityscorematchedstudy AT yisiwangmph supraannularversusintraannularselfexpandingvalvesinsmallaorticannulusapropensityscorematchedstudy AT floydthomabs supraannularversusintraannularselfexpandingvalvesinsmallaorticannulusapropensityscorematchedstudy AT ambermakanimd supraannularversusintraannularselfexpandingvalvesinsmallaorticannulusapropensityscorematchedstudy AT dustinklinermd supraannularversusintraannularselfexpandingvalvesinsmallaorticannulusapropensityscorematchedstudy AT catalintomamd supraannularversusintraannularselfexpandingvalvesinsmallaorticannulusapropensityscorematchedstudy AT davidwestmd supraannularversusintraannularselfexpandingvalvesinsmallaorticannulusapropensityscorematchedstudy AT dereksernagallegosmd supraannularversusintraannularselfexpandingvalvesinsmallaorticannulusapropensityscorematchedstudy AT ibrahimsultanmd supraannularversusintraannularselfexpandingvalvesinsmallaorticannulusapropensityscorematchedstudy |