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Not so SMART: phenotype and outcomes of small aortic valve annulus
Session:
Sessão de Posters 31 - Intervenção transcateter na válvula aórtica: acesso, futilidade e anatomia complexa
Speaker:
Marta Paralta De Figueiredo
Congress:
CPC 2026
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Marta Paralta de Figueiredo; Rafael Viana; Rita Louro; Raquel Silva; António Almeida; Diogo Brás; Rita Rocha; David Neves; Gustavo Mendes; Filipe Alpalhão; Lino Patrício
Abstract
<p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">Introduction: Transcatheter aortic valve implantation (TAVI) has revolutionized the management of severe aortic stenosis (AS). However, some factors, such as aortic valve annular size, remain critical to procedural success. </span></span></p> <p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">Purpose: We aimed to characterize patients(pts) with SAA undergoing TAVI, compare outcomes with the self-expanding valve (SEV) group of SMART trial, and identify predictors for adverse events.</span></span></p> <p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">Methods: We retrospectively analyzed patients who underwent TAVI at our institution between 2021 and 2024. SAA was defined as an aortic annulus area (AAA) lower than 4,3cm<sup>2</sup> on CT. We documented demographic, echocardiographic and CT-scan pre-TAVI data. Outcome was a composed by death, stroke or heart failure hospitalization (HFh). </span></span></p> <p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">Results: We included 300 pts, with 55% (n=166) having SAA, which was predominantly female (80,7%, n=134), with a mean age of 83 ± 5 years and mean STS 5,8± 5,2%. Table1 represents characteristics of our and SMART trial pts. Our pts had a median aortic gradient of 50,4±13,6 mmHg, mean maximum velocity of 4.5±0.57 m/s, mean aortic valvular area of 0.71 ± 0.21 cm² and an AAA of 3,6±0,47 cm². 98% of our pts were submitted to SEV. Mean follow-up was 599 ± 339 days, with the outcome occurring in 21.7% of pts (death 10.8%, stroke 5.4%, HFh 6.0%). Our population had a higher incidence of composed outcome (21% vs. 9.4%), with differences across components: death (10.8% vs. 5.1%), stroke (5.4% vs. 3.1%), and HFh (6% vs. 3.8%).Univariate analysis showed associations between the outcome and atrial fibrillation (AF; 44% vs. 13.5%, p<0.001), previous myocardial infarction (MI; 13.9% vs. 3.9%, p=0.028), glomerular filtration rate (GFR) below 30 mL/min/1.73 m² (33.3% vs. 6.3%, p<0.001), and higher STS scores (8.5% vs. 5.4%, p=0.028). Multivariate analysis identified AF and GFR below 30 mL/min/1.73 m² as independent predictors of the primary outcome.</span></span></p> <p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">Conclusion: Primary outcome was higher in our population compared to the SMART trial. Differences in pts characteristics may explain these disparities. Despite a lower prevalence of cardiovascular events, our cohort was older, had higher STS scores, and a smaller aortic annulus area. AF, GFR below 30 mL/min/1.73 m², previous MI, and higher STS scores were associated with the composite outcome, with AF and lower GFR identified as independent predictors.</span></span></p>
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