Self-Expandable Transcatheter Aortic Valves in Patients With Small Aortic Annulus - The SWEDEHEART Registry

Q: Which valve types were compared, and how were analyses adjusted?

Supra-annular self-expandable valves (Evolut, Acurate) were compared with intra-annular self-expandable valves (Portico, Navitor). Inverse probability of treatment weighting was used to adjust the comparison.

Q: What were the main findings on clinical and hemodynamic outcomes?

Clinical outcomes were comparable after adjustment, with a marginally lower risk of postprocedural mortality for Portico/Navitor versus Evolut. Hemodynamically, Evolut valves showed the lowest mean gradients, followed by Portico/Navitor and Acurate.

Sep 29, 2026

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Small aortic annulus is linked to worse hemodynamic results after transcatheter aortic valve replacement (TAVR). In this Swedish registry-based study, supra-annular (SA) self-expandable valves were compared with intra-annular (IA) self-expandable valves in patients treated from 2013–2022. Using inverse probability of treatment weighting, clinical outcomes were broadly similar, with a slightly lower adjusted postprocedural mortality for Portico/Navitor. Hemodynamics favored Evolut for mean gradients.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Article history

Background

Methods

Results

Conclusions

Keywords

Introduction

Structural Heart 9 (2025) 100680 Articles and Issues Available at ScienceDirect Structural Heart journal [homepage:](homepage: www.structuralheartjournal.org)[ www.structuralheartjournal.org](homepage: www.structuralheartjournal.org) | Original Research
Self-Expandable Transcatheter Aortic Valves in Patients With Small Aortic Annulus: The SWEDEHEART Registry | | | | | --- | --- | --- | --- | | Antros Louca, MD a, b, 1, * , Anna Myredal, MD, PhD a, b, 1, Monr Alchay, MD a, b , Henrik Hagstr€om, MD, PhD c, d, Dan Ioanes, MD, PhD b, Stefan James, MD, PhD e, Sasha Koul, MD, PhD f, Araz Rawshani, MD, PhD a, b, Bj€orn Redfors, MD, PhD a, b,
Andreas Rück, MD, PhD g , Kristofer Skoglund, MD, PhD a, b, Sebastian V€olz, MD, PhD a, b , Petur Petursson, MD, PhD a, b, Truls Råmunddal, MD, PhD a, b, Oskar Angerås, MD, PhD a, b
a Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
b Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden c Department of Public Health and Clinical Medicine, Umeå University, Umeå d Heart Centre, Umeå University Hospital, Umeå, Sweden
e Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden f Department of Clinical Sciences, Cardiology, Lund University Hospital, Lund, Sweden
g Department of Cardiology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden | | | | | A R T I C L E I N F O | | A B S T R A C T | | | Article history:
Submitted 26 March 2025
Revised 3 June 2025
Accepted 5 June 2025
Available online 18 June 2025 | | Background: Small aortic annulus is associated with poorer hemodynamic outcomes in transcatheter aortic valve replacement (TAVR). In these cases, supra-annular (SA) self-expandable valves (SEVs) may offer better results than intra-annular SEVs (IA SEVs). This study evaluated clinical and hemodynamic outcomes for SA SEVs (Evolut valves, Acurate valves) and IA SEVs (Portico/Navitor valves).
Methods: We analyzed data from patients who underwent TAVR in Sweden between 2013 and 2022 with an annular diameter 􀀁23 mm, using inverse probability of treatment weighting. Endpoints included mortality, device, and technical success as per Valve Academic Research Consortium 3 deﬁnitions. Other endpoints were the incidence of post-TAVR mean or peak gradients over 20 and 40 mmHg, respectively, signiﬁcant paravalvular leakage, new pacemaker implantation, and postprocedural aortic valve gradients.
Results: The study included 1068 patients, with a median age of 81.2 years, and 88% were women. After inverse probability of treatment weighting adjustment, no differences were observed in the outcomes apart from a marginally lower risk of postprocedural mortality in the Portico/Navitor valves compared to the Evolut valves (adjusted odds ratio: 0.99; p ¼ 0.05; 95% CI: 0.98-1.00). Hemodynamically, the Evolut valves showed the lowest mean gradients, followed by the Portico/Navitor valves and the Acurate valves (7.97 vs 9.02 mmHg vs. 0.84 mmHg, respectively, p < 0.001; 95% CI: 0.35-1.00).
Conclusions: SA and IA SEVs show comparable clinical outcomes and excellent hemodynamic performance inpatients with small aortic annuli. Further studies, including randomized trials, are needed to provide clearer guidance on valve selection.
aOR, adjusted odds ratio; BEV, balloon-expandable valve; CI, conﬁdence interval; EUROSCORE, European system for cardiac operative risk evaluation; HR, hazards ratio; IA, intra-annular; IPTW, inverse probability of treatment weighting; IQR, interquartile range; PPM, prosthesis-patient mismatch; PVL, paravalvular leak/leakage; SA, supraannular; SAA, small aortic annulus; SEV, self-expandable valves; SMART trial, self-expanding or balloon-expandable TAVR in patients with small aortic annulus; SMD, standardized mean difference; SWEDEHEART initiative, Swedish Web-system for Enhancement and Development of Evidence-b

FAQs

What problem does the study address in TAVR patients with a small aortic annulus?

Small aortic annulus is associated with poorer hemodynamic outcomes after TAVR. The study evaluates whether supra-annular and intra-annular self-expandable valves perform differently in this setting.

Which valve types were compared, and how were analyses adjusted?

Supra-annular self-expandable valves (Evolut, Acurate) were compared with intra-annular self-expandable valves (Portico, Navitor). Inverse probability of treatment weighting was used to adjust the comparison.

What were the main findings on clinical and hemodynamic outcomes?

Clinical outcomes were comparable after adjustment, with a marginally lower risk of postprocedural mortality for Portico/Navitor versus Evolut. Hemodynamically, Evolut valves showed the lowest mean gradients, followed by Portico/Navitor and Acurate.

Sep 29, 2026

Upload by Mia