VALVULAR AND STRUCTURAL HEART DISEASES
Impact of Small Prosthesis Size on Transcatheter or
Surgical Aortic Valve Replacement Outcomes
, Omar K. Khalique,
, Codruta Chiuzan,
, Michael A. Borger,
, Rebecca T. Hahn,
Martin B. Leon,
, Susheel K. Kodali,
Objectives: Determine the comparative impact of small prosthesis size on transcath-
eter and surgical aortic valve replacement (SAVR) outcomes.
with small aortic annuli tend to have worse postoperative outcomes and hemodynam-
ics. We sought to describe surgical outcomes in patients with very small aortic annuli
and then compare early hemodynamic and clinical outcomes in patients undergoing
surgical or transcatheter aortic valve replacement (TAVR) with the smallest available
valves to assist in optimal prosthesis selection for this challenging patient population.
Methods: A retrospective single-center study comparing patient data from 2143 patients
undergoing SAVR with valves having a true internal diameter (ID) of 19 mm with 130
patients receiving surgical valves with true ID’s <19 mm (SmSAVR). Outcomes of SmSAVR
patients were then compared with 40 patients undergoing TAVR receiving small valves
(SmTAVR). A representative SmSAVR cohort was then compared with the SmTAVR
patients for post-operative hemodynamics.
Results: Receiving a small surgical valve
may significantly increase 1-year mortality compared with standard-sized surgical valves
(HR 1.93; 95% confidence interval 1.03–3.61). SmTAVR patients had significantly shorter
lengths of stay than SmSAVR (median 5 vs. 9 days), and significantly better postoperative
hemodynamic profiles (mean gradient 13.4 6 7.8 vs. 18.1 6 8.4 mm Hg, P 5 0.006, peak
velocity of 2.5 6 0.6 vs. 2.9 6 0.6 m/s, P 5 0.003).
Conclusions: TAVR is a safe and
reasonable option for patients with small aortic annuli and is associated with shorter
hospital stays and more favorable postoperative hemodynamic outcomes compared
2017 Wiley Periodicals, Inc.
Key words: aortic valve stenosis; transcatheter aortic valve replacement; cardiology;
Additional Supporting Information may be found in the online
version of this article.
Division of Cardiothoracic Surgery, New York Presbyterian
Hospital – College of Physicians and Surgeons of Columbia
University, New York
Division of Cardiology, New York Presbyterian Hospital –
College of Physicians and Surgeons of Columbia University,
Department of Biostatistics, Mailman School of Public Health,
Columbia University, New York
Conflict of interest: There are no further conflicts of interest to dis-
close, other than Drs. George receiving consulting and speaker fees
from Edwards Lifesciences and Medtronic, Dr. Kodali receiving
consulting fees from Medtronic, and Dr. Borger receiving speaking
honoraria from Medtronic and Edwards. Dr. Smith and Dr. Leon are
the Principal Investigators of the PARTNER and PARTNER 2 Trial
and Dr. Kodali is the Principle Investigator of the PARTNER 3
Trial, all for which travel and customary expenses associated with
Trial management are reimbursed by the sponsor, Edwards Life
*Correspondence to: Isaac George, MD, Assistant Professor of Sur-
gery, Division of Cardiothoracic Surgery, College of Physicians and
Surgeons of Columbia University, New York Presbyterian Hospital,
MHB 7GN-435, 177 Fort Washington Ave, NY 10032.
Received 10 April 2017; Revision accepted 13 April 2017
Published online 4 May 2017 in Wiley Online Library
2017 Wiley Periodicals, Inc.
Catheterization and Cardiovascular Interventions 91:765–773 (2018)