TAVR has similar outcomes as SAVR in Patients with Small Aortic Annulus: JAHA

A recent study published in the Circulation Journal found neither surgical nor transcatheter techniques are clearly preferable for treating severe aortic stenosis (AS) in individuals with a small aortic annulus (SAA).

Fifteen university hospitals participated in the study, which included 151 patients with severe Acute Syndrome and SAA (aortic annulus diameter < twenty-three mm). Transcatheter aortic valve replacement (TAVR) was performed on half of the participants, whilst standard surgical aortic valve replacement (SAVR) was performed on the other half.

Assessing valve hemodynamics and clinical results was the main goal. Using Doppler-echocardiography, the researchers specifically searched for moderate-severe aortic regurgitation (AR) and severe prosthesis patient mismatch (PPM) at the 60-day mark.

The incidence of severe PPM was 5.6% in the TAVR group and 10.3% in the SAVR group. Moderate-severe AR was non-existent in both groups. Further secondary outcomes like mortality and stroke at 30 days, and even longer-term outcomes after a median follow-up of 2 years, showed no significant differences between the two approaches.

The findings indicate that both TAVR and SAVR appear to be valid alternatives for treating patients with severe AS and SAA, but the choice may ultimately depend on individual patient characteristics, anatomical risk factors, and patient preferences.

The limited sample size raises concerns about its statistical power, making it crucial to confirm these findings in larger studies. Despite this, it represents a significant step in understanding the most effective approach to treatment for this specific group of patients.

In the world of cardiac interventions, it's another reminder of the value of tailored medicine – one size does not fit all. As research in the field continues to evolve, these findings underscore the need for personalized treatment decisions that consider each patient's unique medical profile, ensuring the best possible outcomes for those with severe AS and SAA.

Reference:

Rodés-Cabau, J., Ribeiro, H., Mohammadi, S., Serra, V., Al-Atassi, T., Iniguez, A., Vilalta, V., Nombela-Franco, L., Saez de Ibarra, J. I., Kalavrouziotis, D., … Pibarot, P. (2023). Transcatheter or Surgical Aortic Valve Replacement in Patients with Severe Aortic Stenosis and Small Aortic Annulus: A Randomized Clinical Trial. In Circulation. Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1161/circulationaha.123.067326