Transcatheter Aortic Valve Implantation in Patients With Severe Aortic Stenosis and Small Aortic Annulus

Objectives hemodynamics and clinical outcomes among patients with a small aortic annulus who underwent transcatheter aortic valve implantation (TAVI) were examined. ound esence of a small aortic annulus may complicate the surgical management of patients with severe aortic stenosis (AS). TAVI is an alternative to aortic valve replacement (AVR) in high-risk patients, but few data exist on the results of TAVI in patients with a small aortic annulus. s n 2007 and 2010, 35 patients (mean age 79.2 ± 9.4 years) with severe AS and an aortic annulus diameter <20 mm (mean 18.5 ± 0.9 mm) underwent TAVI with a 23-mm Edwards SAPIEN bioprosthesis (Edwards Lifesciences, Inc., Irvine, California). Echocardiographic parameters and clinical outcomes were assessed prior to discharge and at 6, 12, and 24 months. s ural success was achieved in 34 patients (97.1%). There was 1 in-hospital death. Peak and mean transaortic gradients decreased from 76.3 ± 33.0 mm Hg and 45.2 ± 20.6 mm Hg at baseline to 21.8 ± 8.4 mm Hg and 11.7 ± 4.8 mm Hg post-procedure, respectively, both p < 0.0001. Mean indexed effective orifice area (IEOA) increased from 0.35 ± 0.10 cm2/m2 at baseline to 0.90 ± 0.18 cm2/m2 post-procedure, p < 0.0001. Severe prosthesis–patient mismatch (IEOA <0.65 cm2/m2) occurred in 2 patients (5.9%). At a mean follow-up of 14 ± 11 months, gradients remained low and 30 of the 31 remaining survivors were in New York Heart Association functional class I or II. sions h-risk patients with severe AS and a small aortic annulus, TAVI is associated with good post-procedural valve hemodynamics and clinical outcomes. TAVI may provide a reasonable alternative to conventional AVR in elderly patients with a small aortic annulus.