title: Transcatheter aortic valve implantation in patients with severe aortic stenosis and small aortic annulus.
abstract: OBJECTIVE
  Valve hemodynamics and clinical outcomes among patients with a small aortic annulus who underwent transcatheter aortic valve implantation (TAVI) were examined.
  
  
  BACKGROUND
  The presence of a small aortic annulus may complicate the surgical management of patients with severe aortic stenosis (AS). TAVI is an alternative to aortic valve replacement (AVR) in high-risk patients, but few data exist on the results of TAVI in patients with a small aortic annulus.
  
  
  METHODS
  Between 2007 and 2010, 35 patients (mean age 79.2 ± 9.4 years) with severe AS and an aortic annulus diameter <20 mm (mean 18.5 ± 0.9 mm) underwent TAVI with a 23-mm Edwards SAPIEN bioprosthesis (Edwards Lifesciences, Inc., Irvine, California). Echocardiographic parameters and clinical outcomes were assessed prior to discharge and at 6, 12, and 24 months.
  
  
  RESULTS
  Procedural success was achieved in 34 patients (97.1%). There was 1 in-hospital death. Peak and mean transaortic gradients decreased from 76.3 ± 33.0 mm Hg and 45.2 ± 20.6 mm Hg at baseline to 21.8 ± 8.4 mm Hg and 11.7 ± 4.8 mm Hg post-procedure, respectively, both p < 0.0001. Mean indexed effective orifice area (IEOA) increased from 0.35 ± 0.10 cm(2)/m(2) at baseline to 0.90 ± 0.18 cm(2)/m(2) post-procedure, p < 0.0001. Severe prosthesis-patient mismatch (IEOA <0.65 cm(2)/m(2)) occurred in 2 patients (5.9%). At a mean follow-up of 14 ± 11 months, gradients remained low and 30 of the 31 remaining survivors were in New York Heart Association functional class I or II.
  
  
  CONCLUSIONS
  In high-risk patients with severe AS and a small aortic annulus, TAVI is associated with good post-procedural valve hemodynamics and clinical outcomes. TAVI may provide a reasonable alternative to conventional AVR in elderly patients with a small aortic annulus.
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Kalavrouziotis
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Bagur
authors.forename: Daniel
authors.initials: D
authors.lastname: Doyle
authors.forename: Robert
authors.initials: R
authors.lastname: De Larochellière
authors.forename: Philippe
authors.initials: P
authors.lastname: Pibarot
authors.forename: Eric
authors.initials: E
authors.lastname: Dumont
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology; D001024:Aortic Valve Stenosis / Q000473:pathology / Q000601:surgery*; D006328:Cardiac Catheterization; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged