Background Transcatheter aortic valve implantation (TAVI) has been reported to be advantageous over surgical aortic valve replacement owing to the low incidence of prosthesis-patient mismatch (PPM) and large effective orifice area (EOA). However, data on TAVI for extremely small annuli are limited. The present study aimed to compare post-procedural hemodynamics and morphology between 20-mm and 23-mm Sapien XT (SXT) transcatheter heart valves (THVs) with extremely small annuli (< 314 mm2). Methods All patients with severe aortic stenosis treated with TAVI at eight Japanese centers between October 2013 and January 2016 were prospectively included in the Optimized CathEter vAlvular iNtervention (OCEAN-TAVI) registry. In the overall cohort of 20-mm (19 patients) and 23-mm SXTs (492 patients) with extremely small annuli, the patient groups were matched one-to-one using propensity scores, and post-procedural echocardiography and multidetector computed tomography data were compared for 18 matched patients from each group (matched cohort). Results In the matched cohort, the mean gradient was higher (15.4 ± 4.1 vs. 12.2 ± 4.8 mm Hg, p = 0.04), EOA was lower (1.22 ± 0.25 vs. 1.44 ± 0.37 cm2, p = 0.02) and THV area was lower (245.6 ± 19.1 vs. 298.5 ± 33.3 mm2, p < 0.01) in the 20-mm group than in the 23-mm group. However, all patients in both groups were asymptomatic. Although moderate PPM was more prevalent in the 20-mm group than in the 23-mm group (31.6% vs. 7.9%, p < 0.01), the incidence of severe PPM was low and similar between the groups (0% vs. 0.4%, p = 1.00) in the overall cohort. Conclusion A 20-mm SXT in patients who require a small bioprosthesis leads to favorable short-term outcomes.
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