Patients with severe aortic stenosis (AS) and a small aortic annulus (SAA) have been known to face an increased risk of death or major adverse cardiovascular events after surgical aortic valve replacement (SAVR). Is the same trend also seen in patients who undergo transcatheter aortic valve replacement (TAVR)? An international team of researchers hoped to find out, sharing its findings in the American Journal of Cardiology.[1]
“Although most patients with small aortic annulus are women, there is paucity of data on the prognostic impact of small aortic prosthesis in women who underwent TAVR,” wrote first author Carlo A. Pivato, MD, of the Zena and Michael A. Wiener Cardiovascular Institute at Icahn School of Medicine at Mount Sinai in New York City, and colleagues. “Therefore, we aimed to evaluate the impact of small valve size on one-year clinical outcomes after TAVR in women.”
Since the patients most likely to present with AS and a SAA, Pivato et al. tracked data from the Women’s International Transcatheter Aortic Valve Implementation registry. The group focused on 934 women who underwent TAVR at one of 19 facilities in Europe and North America from January 2013 to December 2015.
A total of 41.5% of the patient population underwent TAVR with the implantation of a small aortic valve prosthesis (≤23 mm). These patients tended to have a lower body mass index, lower Society of Thoracic Surgeons (STS) score and lower New York Heart Association classification. They were also less likely to present with atrial fibrillation. When it came to “female-specific” characteristics — the presence of breast cancer and the starting age of menopause, for example — there were no differences between TAVR patients receiving a small aortic valve prosthesis and other TAVR patients.
The study’s primary efficacy endpoint was a composite of all-cause mortality, stroke, myocardial infarction and hospitalization for valve-related symptoms, heart failure or valve-related dysfunction after one year. Overall, this was seen in 16% of patients receiving a small aortic valve prosthesis and 16.3% of all other TAVR patients. There was also not a significant difference between groups when it came to the study’s primary safety endpoint, a composite of all-cause mortality, stroke, major vascular complications, life-threatening bleeding events, stage 2 or stage 3 acute kidney injury, coronary artery obstruction requiring an intervention or valve-related dysfunction requiring a repeat revascularization.
“We found that women receiving a small bioprosthetic valve had similar outcomes to those receiving a non-small valve,” the authors wrote.
The group also noted that their findings seem to disprove the suggestion that women are often linked to better TAVR outcomes due to the use of smaller valves.
“Our data showed no differences between small and non-small valves, which makes annulus size an unlikely explanation of female prognostic benefit after TAVR,” they wrote. “Our findings are consistent with a large patient-level meta-analysis where the female sex emerged as a predictor of improved survival after TAVR, whereas annular size was not.”
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.