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

Objectives Valve hemodynamics and clinical outcomes among patients with a small aortic annulus who underwent transcatheter aortic valve implantation (TAVI) were examined. Background The presence 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. Methods Between 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. Results Procedural 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 cm(2)/m(2) at baseline to 0.90 +/- 0.18 cm(2)/m(2) post-procedure, p < 0.0001. Severe prosthesis-patient mismatch (IEOA < 0.65 cm(2)/m(2)) 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. Conclusions In high-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. (J Am Coll Cardiol 2011; 58: 1016-24) (C) 2011 by the American College of Cardiology Foundation