SPC365

Finding the perfect match: profiling aortic annulus in TAVI patients

Session: SESSÃO DE COMUNICAÇÕES ORAIS 08 – OTIMIZAR RESULTADOS NA TAVI: PERFIL DO DOENTE, TÉCNICAS E VÁLVULAS
Speaker: Ana Lobato De Faria Abrantes

Congress: CPC 2025
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Session Type: Comunicações Orais
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Authors: Ana Lobato de Faria Abrantes; Catarina Gregório; Miguel Azaredo Raposo; Daniel Cazeiro; João Cravo; Marta Vilela; Sofia Esteves; Miguel Nobre Menezes; Cláudia Jorge; Pedro Carrilho Ferreira; Pedro Cardoso; Fausto J. Pinto

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Introduction:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"> Transcatheter Aortic Valve Implantation (TAVI) has become the standard treatment for severe aortic stenosis (SAS) in elderly or high-risk patients. Accurate aortic annulus (AA) sizing is crucial for successful TAVI, as incorrect prosthesis sizing can lead to adverse outcomes.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Purpose: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">To describe AA characteristics and evaluate differences in TAVI outcomes when comparing implanted prosthesis size to brand recommended size (BRS), according to AA measurement.</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Methods:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"> Single center retrospective study of consecutive pts with SAS who underwent TAVI from 2014 to November 2023. AA measurements were obtained via computed tomography scan revised by an interventional cardiologist. AA was classified as small if below 10th percentile and large if above the 90th percentile. For each pt we evaluated all possible prosthesis options, based exclusively on AA measurement, matching the recommended size provided by the respective brands (Sapien, Evolut, Navitor, Accurate, Myval). Oversizing was defined as an oversizing index above 20% for self expandable valves and 10% for balloon expandable valves. Elderly pts were defined as age above 75. Kaplan-Meier survival analyses were used to compare the outcomes between groups.&nbsp;</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Results: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">We included 580 pts,&nbsp; 45% men with a mean age of 84&plusmn;8 years. AA dimension characteristics are shown in Figure 1. Women and elderly patients had significantly smaller AA diameters (Ad) and perimeters (Ap) compared to men and younger patients (Sex: Ad 22&plusmn;2 vs 25&plusmn;2, Ap 69&plusmn;6 vs 78&plusmn;7, p&lt;0.001; Age: Ad 23&plusmn;2 vs 25&plusmn;3, Ap 73&plusmn;7 vs 77&plusmn;9, p&lt;0.001). Distribution of pts according to BRS prostheses is present in Figure2, all patients had at least one prosthetic size suitable for their AA. Sapien 26, Sapien 23 and Evolut 26 and 29 accounted for 83% of the implanted valves. The size of the implanted valve differed from the BRS in 82% of patients, with 67% receiving a larger prosthesis. Elderly patients and men had a 2-fold and 2.3-fold increased likelihood of receiving a larger valve, respectively (OR 0.48 [0.21-0.91], p=0.026; OR 2.3 [1.5-3.5], p=0.004). Receiving a prosthesis larger than BRS significantly increased the risk of procedural complications (OR 1.6 [1.1-2.5], p=0.015), oversizing (OR 6.1 [3.3-11.8], p&lt;0.001), and the need for pacemaker implantation (35.6% vs 24.5%, OR 1.76 [1.1-2.8], p=0.016) during a mean follow-up of 39 months (Figure 3). However, no differences were found regarding prosthetic function, death, or heart failure hospitalization during follow-up.</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Conclusion: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">These findings highlight the importance of precise AA measurement and careful prosthesis selection to minimize procedural risks and improve patient outcomes.</span></span></span></p>

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