Extremely Small 20-mm Versus Standard-Size Balloon-Expandable Transcatheter Heart Valves: Propensity-Matched Analysis From the OCEAN-TAVI Registry.

• Tác giả: Yoshihiro J Akashi, Masahiko Asami, Kentaro Hayashida, Masaki Izumo, Masashi Koga, Shingo Kuwata, Kazuki Mizutani, Toru Naganuma, Hidetaka Nishina, Masahiko Noguchi, Yohei Ohno, Taishi Okuno, Toshiaki Otsuka, Shinichi Shirai, Norio Tada, Kensuke Takagi, Kai Takahiko, Hiroshi Ueno, Yusuke Watanabe, Masanori Yamamoto, Futoshi Yamanaka, Fumiaki Yashima
• Ngôn ngữ: eng
• Thông tin xuất bản: United States : JACC. Asia , 2025
• Bộ sưu tập: NCBI
• ID: 208534

Tóm tắt

 BACKGROUND: The 20-mm balloon-expandable transcatheter heart valve (THV) represents the smallest available option for transcatheter aortic valve replacement (TAVR). Its current underutilization stems from concerns regarding prosthesis-patient mismatch, durability, and potential adverse outcomes. OBJECTIVES: The purpose of this study was to compare the long-term outcomes between the 20-mm balloon-expandable THVs and standard-size balloon-expandable THVs. METHODS: Patients who underwent transfemoral TAVR with SAPIEN THVs were sourced from the OCEAN-TAVI (Optimized Transcatheter Valvular Intervention) registry, an ongoing, multicenter cohort study that has enrolled over 7,000 TAVR patients in Japan. A 1:3 propensity-matched analysis, based on 24 baseline clinical and echocardiographic variables, was used to contrast the 20-mm with >
 20-mm balloon-expandable THVs. RESULTS: Of 5,086 eligible patients, 284 (5.6%) received the 20-mm balloon-expandable THV. After propensity-matching, the 20-mm THV group (n = 276) and the >
 20-mm THV group (n = 828) demonstrated balanced baseline characteristics, with an absolute standardized difference <
 0.10. The average follow-up duration for patients who were alive was 955 ± 512 days, and the average time to death was 584 ± 543 days. The 20-mm group showed a higher frequency of prosthesis-patient mismatch (PPM) (moderate PPM: 29.2% vs 10.8%
  severe PPM: 4.9% vs 1.5%
  P <
  0.001). Over a 5-year period, all-cause mortality and heart failure rehospitalization rates were comparable between the 2 groups (all-cause mortality: 34.2% vs 38.0%
  HR: 1.01
  95% CI: 0.74-1.37
  P = 0.970
  heart failure rehospitalization: 15.2% vs 16.3%
  HR: 0.81
  95% CI: 0.50-1.29
  P = 0.371). CONCLUSIONS: This registry-based study suggests that the initially observed inferior forward hemodynamics associated with the 20-mm THV do not translate into heightened long-term mortality or heart failure rehospitalization risks. (The OCEAN-TAVI registry [Optimized Transcatheter Valvular Intervention-Transcatheter Aortic Valve Implantation]
  UMINID:000020423).