SPC365

Is SMART enough? BEV vs SEV in patients with small aortic annuli

Session: SESSÃO DE COMUNICAÇÕES ORAIS 08 – OTIMIZAR RESULTADOS NA TAVI: PERFIL DO DOENTE, TÉCNICAS E VÁLVULAS
Speaker: Sofia Esteves

Congress: CPC 2025
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.4 Interventional Cardiology - Other
Session Type: Comunicações Orais
FP Number: ---
Authors: Sofia Esteves; Miguel Azaredo Raposo; Miguel Nobre Menezes; Ana Abrantes; Catarina Santos Gregório; Diogo Rosa Ferreira; Inês Caldeira de Araújo; Cláudia Moreira Jorge; João Silva Marques; Pedro Carrilho Ferreira; Pedro Pinto Cardoso; Fausto J. Pinto

<p><span style="font-family:Arial,Helvetica,sans-serif"><strong><span style="font-size:12pt"><span style="color:#000000">Introduction:&nbsp;</span></span></strong><span style="font-size:12pt"><span style="color:#000000">The recently published SMART randomized trial showed self-expanding aortic valves (SEV) to be non-inferior to balloon-expandable valves (BEV) among patients with </span></span><span style="font-size:12pt"><span style="background-color:#ffffff"><span style="color:#444444">aortic stenosis and a small aortic annulus &nbsp;(defined as </span></span></span></span><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><span style="color:#444444"><span style="background-color:#ffffff">CT area &le;4.3 cm<sup>2</sup></span></span></span></span><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><span style="color:#444444"><span style="background-color:#ffffff">)&nbsp;</span></span></span></span><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><span style="background-color:#ffffff"><span style="color:#444444">undergoing TAVR. </span></span></span></span></p>

<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><span style="background-color:#ffffff"><span style="color:#000000"><strong>Purpose:</strong>&nbsp;</span></span></span><span style="font-size:12pt"><span style="color:#000000">To </span></span><span style="font-size:12pt"><span style="color:#444444"><span style="background-color:#ffffff">evaluate outcomes of SEV compared with BEV among patients&nbsp;who underwent TAVR and had a small aortic annulus.&nbsp;</span></span></span></span></p>

<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><span style="color:#444444"><span style="background-color:#ffffff"><strong>Methods:&nbsp;</strong></span></span></span><span style="font-size:12pt"><span style="color:#000000">Retrospective single center study, studying patients&nbsp;submitted to TAVR from 2013 to 2023. Clinical, echocardiographic, and computer tomography data were analyzed.&nbsp;</span></span><span style="font-size:12pt"><span style="color:#444444"><span style="background-color:#ffffff">Small aortic annulus was defined as CT area &le;4.3 cm2.&nbsp;</span></span></span><span style="font-size:12pt"><span style="color:#000000">&nbsp;For statistical analysis, independent samples t-test, Chi-square, Kaplan-Meier curves and Cox regression were used.&nbsp;</span></span></span></p>

<p><span style="font-family:Arial,Helvetica,sans-serif"><strong><span style="font-size:12pt"><span style="color:#444444"><span style="background-color:#ffffff">Results:&nbsp;</span></span></span></strong><span style="font-size:12pt"><span style="color:#444444"><span style="background-color:#ffffff">We analyzed a population of 351 patients, 52% of whom received a SEV and 48% a BEV. Mean follow-up (FUP) time was 37.7&plusmn;24.3 months. Regarding demographics and comorbidities (table 1), female sex was the only significatively different factor, with 66% females in the SEV group and 53% in the BEV.&nbsp;</span></span></span><span style="font-size:12pt"><span style="color:#444444"><span style="background-color:#ffffff">Echocardiographic evaluation at discharge showed similar results for SEV and BEV regarding maximum (SEV: 17 vs BEV: 19 mmHg) and mean (SEV: 9 vs BEV: 10 mmHg) transprosthetic gradients. Doppler velocity index (DVI) was significatively lower for BEV (SEV: 0.6 vs BEV: 0.5, p=0.02). Reevaluation at 1year post procedure revealed reduced maximum (SEV: 16 vs BEV:&nbsp;22&nbsp; p&lt;.01) and medium (SEV: 8 vs BEV: 11 p&lt;.01)&nbsp; gradients comparing to BEV , as well as higher DVI (SEV: 0.62 vs BEV: 0.49 p=0.05).&nbsp;</span></span></span><span style="font-size:12pt"><span style="color:#444444"><span style="background-color:#ffffff">Analyzing outcomes at 1 year, there were no significative differences regarding death (SEV: 17 vs BEV: &nbsp;23); valve dysfunction defined as mean gradient &ge;20 mm (SEV: 4% vs BEV: 5%) and moderate to severe leak (SEV: 5% vs BEV: 2.5%). As for outcomes at FUP, stroke and cardiovascular admission had no significative difference. Permanent pacemaker implantation (PPI) was similar during index admission (SEV: 27% vs BEV: 23% p=NS). However, at FUP, SEV had higher need for PPI (SEV: 35% vs BEV: 22% p=0.01).&nbsp;</span></span></span><span style="font-size:12pt"><span style="color:#444444"><span style="background-color:#ffffff">Survival analysis shows a 43% higher hazard of death at a mean FUP of 38 months for BEV comparing to SEV.<strong>&nbsp;</strong></span></span></span><span style="font-size:12pt"><span style="color:#444444"><span style="background-color:#ffffff"><strong>Conclusion:</strong>&nbsp;</span></span></span><span style="font-size:12pt"><span style="color:#444444"><span style="background-color:#ffffff">The SMART trial showed non-inferiority of SEV choice vs BEV in patients with small aortic annuli. Our analysis suggests it may in fact be superior, reducing transvalvular gradients at 1 year and overall mortality at a mean FUP of 38 months. Larger, multicentric trials are required to confirm this hypothesis.&nbsp;</span></span></span></span></p>