title: Transcatheter aortic valve implantation in patients with small aortic annuli using a 20 mm balloon-expanding valve.
abstract: While transcatheter aortic valve implantation (TAVI) is established for treating high-operative risk surgical aortic valve replacement candidates, until recently the smallest transcatheter heart valve (THV) measured 23 mm, posing greater risk for annular rupture and THV failure in patients with aortic stenosis (AS) with small aortic annuli (≤20 mm).
  
  
  
  In the setting of a multicentre registry, we report on the safety, efficacy and early clinical outcomes of the SAPIEN XT 20 mm balloon-expanding THV.
  
  
  
  Among TAVI 55 recipients (n=30 for native AS, n=25 for a valve-in-valve procedure (V-in-V)), median age and Society of Thoracic Surgeons score were 85 (81 to 87) years and 7.8 (4.7 to 12.4)%, respectively. Mean and minimum annular diameters were 19±1 and 17±2 mm, respectively, in native patients with AS, and 17±1 mm (internal diameter) in V-in-V recipients. Successful device implantation rate was 96%, with no procedural-related death. Overall in-hospital-30-day death, stroke and major bleeding rates were 5%, 2% and 9%, respectively. In native AS TAVI recipients, mean transaortic gradient decreased from 54±20 to 12±5 mm Hg (p<0.001), and from 45±17 to 24±8 mm Hg (p<0.001) in V-in-V recipients. Severe prosthesis-patient mismatch (PPM) rates were 10% and 48% in native AS and V-in-V TAVI recipients, respectively (p=0.03). Post-TAVI, the rate of moderate aortic regurgitation was 7% and 0% in native AS and V-in-V TAVI recipients, respectively.
  
  
  
  TAVI with the 20 mm SAPIEN XT THV appears safe and technically feasible, with acceptable short-term clinical outcomes and low rates of severe PPM in those with native AS.
authors.affiliation: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Rishi
authors.initials: R
authors.lastname: Puri
authors.affiliation: King's College Hospital, London, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Byrne
authors.affiliation: Helios Klinikum Siegburg, Siegburg, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Muller
authors.affiliation: Robert-Bosch-Krankenhaus, Stuttgart, Germany.
authors.forename: Hardy
authors.initials: H
authors.lastname: Baumbach
authors.affiliation: Hôpital Charles-Nicolle, Rouen, France.
authors.forename: Helene
authors.initials: H
authors.lastname: Eltchaninoff
authors.affiliation: St. Thomas' Hospital, London, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Redwood
authors.affiliation: St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Asim
authors.initials: A
authors.lastname: Cheema
authors.affiliation: Universitaire Ziekenhuizen and Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: Christophe
authors.initials: C
authors.lastname: Dubois
authors.affiliation: Helsinki University Hospital, Helsinki, Finland.
authors.forename: Leo
authors.initials: L
authors.lastname: Ihlberg
authors.affiliation: Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Harindra C
authors.initials: HC
authors.lastname: Wijeysundera
authors.affiliation: G. Pasquinucci Hospital, Massa, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Cerillo
authors.affiliation: Skane University Hospital, Lund, Sweden.
authors.forename: Matthias
authors.initials: M
authors.lastname: Götberg
authors.affiliation: Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Kaj Erik
authors.initials: KE
authors.lastname: Klaaborg
authors.affiliation: New Brunswick Heart Centre, Saint John, New Brunswick, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: Pelletier
authors.affiliation: Hospital Universitario de Cruces, Baracaldo, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Blanco-Mata
authors.affiliation: Freeman Hospital, Newcastle Upon Tyne, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Edwards
authors.affiliation: ARNAS Ospedale Civico, Palermo, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Gandolfo
authors.affiliation: The James Cook University Hospital, Middlesbrough, UK.
authors.forename: Douglas
authors.initials: D
authors.lastname: Muir
authors.affiliation: Azienda Ospedaliero Universitaria Careggi Largo Brambilla, Florence, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Meucci
authors.affiliation: University Hospital Bonn, Bonn, Germany.
authors.forename: Jan-Malte
authors.initials: JM
authors.lastname: Sinning
authors.affiliation: University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Pieter
authors.initials: P
authors.lastname: Stella
authors.affiliation: University Hospital Dusseldorf, Dusseldorf, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Veulemans
authors.affiliation: Tampere University Hospital, Tampere, Finland.
authors.forename: Marko
authors.initials: M
authors.lastname: Virtanen
authors.affiliation: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Ander
authors.initials: A
authors.lastname: Regueiro
authors.affiliation: Edwards LifeSciences, Nyon, Switzerland.|Léman Research Institute, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Thoenes
authors.affiliation: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Pibarot
authors.affiliation: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Emilie
authors.initials: E
authors.lastname: Pelletier-Beaumont
authors.affiliation: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D002170:Canada / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology; D011474:Prosthesis Design; D012042:Registries; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome