Supra Annular Versus Annular Trans-Catheter Aortic Valve Implantation in Patients with Small Aortic Valve Anatomy: Does it Really Matter? - The 65th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery, 24-25 April 2018

Meir Tabi Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel Yaron Almagor Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel Jonathan Balkin Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel Rami Jubeh Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel David Rosenmann Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel Rivka Farkash Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel Carmit Ben Ami Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel Rafael Wolff Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel

Background: Trans-catheter aortic valve implantation (TAVI) is an established and valuable treatment option for patients with severe symptomatic aortic stenosis. The use of TAVI is rapidly expanding worldwide and the indications for TAVI are widening into lower risk populations in view of favorable outcomes among high and intermediate risk patients. TAVI for patients with smaller aortic valve (AV) anatomy is a challenging procedure due to specific anatomical difficulty and complications including annulus rupture, remaining high AV gradients and vascular complications.

Objective: To compare 30-day and 1-year outcomes between supra annular and annular design TAVI valves implantation in patients with small AV anatomy.

Methods: We have conducted a retrospective study between 2014-2017 including all TAVI patients with small AV anatomy defined by CT AV annulus area < 430 mm2. Annular design valve was the SAPIEN® (Edwards) where the supra-annular valves included the EVOLUT R (Medtronic) and ACURATE Neo (Symetis / Boston).

Results: 146 patients were included in the study. The mean age of the patients was 82.2 ± 6.29 years, 71.9% were women. 87% had normal LV function. In 74 (50.7%) patients the SAPIEN® valve was implanted whereas in 72 (49.3%) patients the supra-annular design valves were used. Mean baseline aortic valve area was 0.57 ± 0.11 cm². Following the TAVI procedure mean AV gradient within the supra-annular group was lower by 3.5 mmHg compared to annular group (P<0.001). Rate of Pacemaker implantation during hospitalization was significantly higher among the supra-annular group compare to the annular group (13.9% vs 1.4%, P=0.004). In hospital stay and mortality rates were similar between the 2 groups

Conclusion: the use of supra annular design valves for TAVI in patients with small AV anatomy resulted with lower post procedural gradients and higher rates of PPM implantation with no effect on major complications or mortality rates.