[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-439115-105":3,"detail-sidebar-cat-0-en-105":80,"doc-detail-439115-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":73,"head_meta":75,"extra_data":77,"updated_unix":79},105,"en","self-expandable-transcatheter-aortic-valves-in-patients-with-small-aortic-annulus-the-swedeheart-registry","Self-Expandable Transcatheter Aortic Valves in Patients With Small Aortic Annulus - The SWEDEHEART Registry","","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.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/research-report/","Research & Report",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/self-expandable-transcatheter-aortic-valves-in-patients-with-small-aortic-annulus-the-swedeheart-registry/439115/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/self-expandable-transcatheter-aortic-valves-in-patients-with-small-aortic-annulus-the-swedeheart-registry/439115.png","ImageObject",300,407,{"name":42,"@type":43},"Mia  ","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-09-30","2026-09-29",true,{"@type":52,"interactionType":53,"userInteractionCount":30},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"What problem does the study address in TAVR patients with a small aortic annulus?","Question",{"text":62,"@type":63},"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.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"Which valve types were compared, and how were analyses adjusted?",{"text":67,"@type":63},"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.",{"name":69,"@type":60,"acceptedAnswer":70},"What were the main findings on clinical and hemodynamic outcomes?",{"text":71,"@type":63},"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.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},439115,1790719005,{"code":4,"msg":81,"data":82},"success",[83,87,91,95,100,105,110,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":84,"show_sort_weight":85,"slug":86},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":88,"show_sort_weight":89,"slug":90},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":92,"show_sort_weight":93,"slug":94},"Exam",70,"exam",{"id":96,"doc_module":4,"doc_module_name":25,"category_name":97,"show_sort_weight":98,"slug":99},5,"Comic",60,"comic",{"id":101,"doc_module":4,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},6,"Technology",50,"technology",{"id":106,"doc_module":4,"doc_module_name":25,"category_name":107,"show_sort_weight":108,"slug":109},7,"Healthcare",40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":112,"slug":113},8,30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":96,"slug":129},19,"General","general",{"code":4,"msg":81,"data":131},{"doc_id":78,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":111,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":30,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":115,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":144},687207024478,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","Structural Heart 9 (2025) 100680  \nArticles and Issues Available at ScienceDirect  \nStructural Heart  \njournal [homepage:](homepage: www.structuralheartjournal.org)[ www.structuralheartjournal.org](homepage: www.structuralheartjournal.org)  \n| Original Research\u003Cbr>Self-Expandable Transcatheter Aortic Valves in Patients With Small Aortic Annulus: The SWEDEHEART Registry |  |  | |\n| --- | --- | --- | --- |\n| 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,\u003Cbr>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 \u003Cbr>a Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden\u003Cbr>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\u003Cbr>e Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden f Department of Clinical Sciences, Cardiology, Lund University Hospital, Lund, Sweden\u003Cbr>g Department of Cardiology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden |  |  |  |\n| A R T I C L E I N F O |  | A B S T R A C T |  |\n| Article history:\u003Cbr>Submitted 26 March 2025\u003Cbr>Revised 3 June 2025\u003Cbr>Accepted 5 June 2025\u003Cbr>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).\u003Cbr>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.\u003Cbr>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 \u003C 0.001; 95% CI: 0.35-1.00).\u003Cbr>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.\u003Cbr>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","cbCainLE0gIPcNe7","https://ap.wps.com/l/cbCainLE0gIPcNe7","pdf",991592,"English","# Article history\n# Background\n# Methods\n# Results\n# Conclusions\n# Keywords\n# Introduction","[{\"question\":\"What problem does the study address in TAVR patients with a small aortic annulus?\",\"answer\":\"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.\"},{\"question\":\"Which valve types were compared, and how were analyses adjusted?\",\"answer\":\"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.\"},{\"question\":\"What were the main findings on clinical and hemodynamic outcomes?\",\"answer\":\"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.\"}]","Self-Expandable Transcatheter Aortic Valves in Patients With Small Aortic Annulus - The SWEDEHEART Registry | PDF",1790687515,23]