TY - JOUR JO - EuroIntervention TI - Implantation of contemporary transcatheter aortic valves in small aortic annuli: the international multicentre TAVI-SMALL 2 registry AB - <p><strong>Background:</strong> Treatment of aortic stenosis in patients with small annuli is challenging and can result in prosthesis-patient mismatch (PPM).</p> <p><strong>Aims:</strong> We aimed to compare the forward flow haemodynamics and clinical outcomes of contemporary transcatheter valves in patients with small annuli.</p> <p><strong>Methods:</strong> The TAVI-SMALL 2 international retrospective registry included 1,378 patients with severe aortic stenosis and small annuli (annular perimeter &lt;72 mm or area &lt;400 mm<sup>2</sup>) treated with transfemoral self-expanding (SEV; n=1,092) and balloon-expandable valves (BEV; n=286) in 16 high-volume centres between 2011 and 2020. Analyses comparing SEV versus BEV and supra-annular (SAV; n=920) versus intra-annular valves (IAV; n=458) included inverse probability of treatment weighting (IPTW). The primary endpoints were the predischarge mean aortic gradient and incidence of severe PPM. The secondary endpoint was the incidence of more than mild paravalvular leak (PVL).</p> <p><strong>Results:</strong> The predischarge mean aortic gradient was lower after SAV versus IAV (7.8&plusmn;3.9 vs 12.0&plusmn;5.1; p&lt;0.001) and SEV versus BEV implantation (8.0&plusmn;4.1 vs 13.6&plusmn;4.7; p&lt;0.001). Severe PPM was more common with IAV and BEV when compared to SAV and SEV implantation, respectively, (8.8% vs 3.6%; p=0.007 and 8.7% vs 4.6%; p=0.041). At multivariable logistic regression weighted by IPTW, SAV protected from severe PPM regardless of its definition. More than mild PVL occurred more often with SEV versus BEV (11.6% vs 2.6%; p&lt;0.001).</p> <p><strong>Conclusions:</strong> In small aortic annuli, implantation of SAV and SEV was associated with a more favourable forward haemodynamic profile than after IAV and BEV implantation, respectively. More than mild PVL was more common after SEV than BEV implantation.</p> AU - Leone Pier Pasquale AU - Regazzoli Damiano AU - Pagnesi Matteo AU - Cannata Francesco AU - Mangieri Antonio AU - Hokken W. Thijmen AU - Costa Giuliano AU - Barbanti Marco AU - Teles Rui Campante AU - Adamo Marianna AU - Taramasso Maurizio AU - Reifart Jorg AU - De Marco Federico AU - Giannini Francesco AU - Kargoli Faraj AU - Ohno Yohei AU - Saia Francesco AU - Buono Andrea AU - Ielasi Alfonso AU - Pighi Michele AU - Chiarito Mauro AU - Bongiovanni Dario AU - Cozzi Ottavia AU - Stefanini G. Giulio AU - Ribichini L. Flavio AU - Maffeo Diego AU - Chizzola Giuliano AU - Bedogni Francesco AU - Kim Won-Keun AU - Maisano Francesco AU - Tamburino Corrado AU - Van Mieghem Nicolas M. AU - Colombo Antonio AU - Reimers Bernhard AU - Latib Azeem VL - IS - Y1 - 21/03/2023 Y1 - 2023 DOI - 10.4244/EIJ-D-22-00843 SP - KW - aortic stenosis KW - other PB - Europa Digital & Publishing UR - https://eurointervention.pcronline.com/article/implantation-of-contemporary-transcatheter-aortic-valves-in-small-aortic-annuli-the-international-multicentre-tavi-small-2-registry SN - 1774-024X ER -