Abstract 19625: Transcatheter Aortic Valve Implantation in Patients With Severe Aortic Stenosis and Small Aortic Annulus
Background: Aortic valve replacement (AVR) in patients with severe aortic stenosis (AS) and a small aortic annulus has been associated with a high incidence of prosthesis-patient mismatch (PPM). An aortic root enlargement may be necessary in these patients, which may increase morbidity and mortality. Transcatheter aortic valve implantation (TAVI) has emerged as an alternative to AVR in high-risk patients with AS, but few data exist on the results of TAVI in patients with a small aortic annulus. We sought to examine valve hemodynamics and early outcomes of patients with a small aortic annulus who underwent TAVI at our institution.
Results: Since 2007, 22 patients (mean age 80 ± 7.5 years, 20 females) with severe AS and an aortic annular diameter ≤ 20 mm (mean 18.7 ± 1.1 mm, range 16.5–20 mm) underwent TAVI with a 23 mm Edwards SAPIEN bioprosthesis at our center. Aortic annular diameter was measured using transesophageal echocardiography. Mean logistic EuroSCORE was 18.4 ± 10.7 and mean Society of Thoracic Surgeons' score was 7.5 ± 3.7; all patients were deemed inoperable by consultant cardiac surgeons. Procedural success was achieved in 21 patients (95.5%). Major procedural and 30-day complications were: valve embolization into the ascending aorta (n=1), LV apical access site bleeding requiring temporary peripheral cardiopulmonary bypass (n=1), and stroke (n=1). There was no in-hospital or 30-day mortality. Maximum and mean transaortic gradients decreased from 75 ± 33 mmHg and 44 ± 19 mmHg at baseline to 20 ± 8 mmHg and 11 ± 4 mmHg post-procedure, respectively, p < 0.0001. Mean effective orifice area (EOA) increased from 0.53 ± 0.14 cm2 at baseline to 1.37 ± 0.29 cm2 post-procedure, p < 0.0001. Mean indexed EOA post-procedure was 0.89 ± 0.21 cm2/m2; severe PPM (IEOA ≤ 0.65 cm2/m2) occurred in 2 patients (9.5%). Aortic insufficiency following TAVI occurred in 15 patients and was ≤ mild (1+) in all cases. At a mean follow-up of 11 months, all patients were alive and in NYHA class I or II.
Conclusions: In high-risk patients with severe aortic stenosis and a small aortic annulus, TAVI is associated with good post-procedural valve hemodynamics and early outcomes. TAVI may provide a reasonable alternative to conventional AVR in elderly patients with a small aortic annulus.
- © 2010 by American Heart Association, Inc.