SPC365

Over- or under-sizing of valve prostheses in TAVR and the importance of a broader range of sizing options to ensure optimal valve fit.

Session: SESSÃO DE POSTERS 51 - DIAGNÓSTICO E PROGNÓSTICO NA INTERVENÇÃO VALVULAR AÓRTICA PERCUTÂNEA
Speaker: Fernando Nascimento Ferreira

Congress: CPC 2025
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 15. Valvular Heart Disease
Subtheme: 15.4 Valvular Heart Disease – Treatment
Session Type: Cartazes
FP Number: ---
Authors: Fernando Nascimento Ferreira; Francisco Albuquerque; Inês Rodrigues; Miguel Figueiredo; Barbara Teixeira; Francisco Cardoso; Mariana Caetano Coelho; Tiago Mendonça; Ruben Ramos; António Fiarresga; Rui Cruz Ferreira; Duarte Cacela

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Introduction</span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">: Transcatheter aortic valve replacement (TAVR) has increasingly been adopted as a key treatment for severe aortic stenosis. As this technique has evolved, a growing number of valve models have been introduced. Among these, balloon-expandable valves have shown promising results in patients with complex or calcified anatomy. The range of valve sizes available has expanded, allowing a precise matching of prostheses to patient anatomy, ultimately enhancing procedural safety and efficacy.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods</span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">: Consecutive patients with severe aortic stenosis who underwent TAVR with balloon-expandable valves (Edwards Sapien) between 2019 and 2023 at a single centre were included. Two groups were defined based on whether the annulus area was compatible with Myval intermediate sizes (IS) or with regular sizes. Peri-procedural safety endpoints, technical success, intervention-related complications, 1-year mortality, and efficacy endpoints as defined by VARC-2 were assessed according to valve sizing. Statistical analysis was performed using the Chi-square test, Mann-Whitney U test, and independent samples t-test. A p-value &lt; 0.05 was considered statistically significant.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results</span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">: Of the 161 patients, 34 (21.1%) met the criteria for Myval intermediate sizes (IS). There were no significant differences between the two groups in terms of demographic characteristics (mean age 82 &plusmn; 7 years, 47,2% female). The group meeting criteria for IS had smaller valve perimeter and annulus area (74.5 &plusmn; 6.1 mm and 416 &plusmn; 69 mm&sup2;, respectively). Regarding the procedure, the most frequently used valve was the Sapien 23mm. Absolute over/under-sizing was significantly higher in the IS group (18.1% [1.7 - 46.67] vs 9.5% [0.1 - 46.7], p&lt;0.05). Although not statistically significant, there was a trend towards a higher rate of pacemaker implantation (32.4% vs 21.3%, p=0.168) and higher mean aortic valve gradients (18.1 mmHg [1.7 - 46.67] vs 9.5 mmHg [0.1 - 46.7]) after TAVR, with only one patient with significant paravalvular leak. There was no statistically significant difference in 1-year mortality between the groups.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusion</span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">: Our study found no significant differences between the two groups regarding peri-procedural safety or technical success following TAVR with balloon-expandable. However, a trend was observed towards higher pacemaker implantation rates and higher mean AV gradients in patients with Myval intermediate size annulus area. These findings suggest that offering a broader range of valve sizes to accurately match the procedure to patient anatomy could influence long-term outcomes. Further studies with larger sample sizes are necessary to validate these trends.</span></span></span></span></span></p>