Transcatheter Aortic Valve Replacement in Male Patients with Large Aortic Valve Annuli: A Propensity-Matched Analysis of Balloon-Expandable versus Self-Expanding Valves

Introduction

Trans-catheter aortic valve replacement (TAVR) in patients with large-annuli poses procedural difficulties and possible complications. These include limited valve availability, paravalvular leak, increased risk for valve migration and patient-prosthesis mismatch (PPM). We sought to compare the outcomes of patients with large annuli undergoing TAVR with self-expanding (SEV) vs. balloon expanding (BEV) valves.

Materials and Methods

We conducted propensity score matching (PSM) of consecutive male patients with large aortic annuli (aortic valve area≥540 mm2) enrolled in a national TAVR registry between the years 2008 and 2023. Patients undergoing TAVR via transapical route and for aortic regurgitation were excluded. Outcomes of patients undergoing TAVR with SEV vs. BEV were compared.

Results

Overall, 552 patients were included in the current analysis (368 BEV; 184 SEV; 80.2±8.2). Baseline characteristics were similar between groups. The rate of paravlvular leak (1.1% vs. 0.3%; p=0.38), conversion to an open surgery (0% vs. 0.3%; p=1.00), coronary obstruction (0.6% vs. 0.0%; p=0.32), annular rupture (0.0% vs. 0.6%; p=0.846), valve migration (0.0% vs. 0.3%; p=1.00), complete AV-block (13% vs. 10.3%; p=0.45), major vascular complications (3.8% vs. 4.1%; p=1.00) and procedural mortality (1.7% vs. 1.2%; p=0.80) was similar between the SEV and BEV groups, respectively. The 3-year mortality rate was higher in the SEV vs. BEV group (29.4% vs. 20.4%; p=0.02) and there was a trend towards higher 5-year mortality in the SEV vs. BEV group (35.0% vs. 28.1%; p=0.11).

Conclusions

Although the rate of peri-procedural complications in patients with large annuli undergoing TAVR with SEV and BEV is similar, there is a trend towards higher mid-term mortality in the SEV group. Further studies are required to ascertain this trend and to elucidate its causes.