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Abstract 15926: Impact of Small Body Surface Area on Para-valvular Leak After Balloon-expandable Transcatheter Aortic Valve Replacement


 Aims:
 The efficacy and safety of balloon-expandable transcatheter aortic valve replacement (TAVR) in patients of small body surface is not well understood. The aim of this study was to evaluate that the efficacy and safety and association between small BSA (S-BSA) and para-valvular leak (PVL) after balloon-expandable TAVR.
 
 
 Methods:
 Between January 2013 and April 2015, a total of consecutive 379 patients with severe aortic stenosis underwent balloon-expandable TAVR (SAPIEN =82 or XT =297) and had suitable contrast cardiac CT. Patients with S-BSA were defined as <1.75cm2. The S-BSA group included 149 patients and the remaining 230 patients were included in the large BSA (L-BSA) group. Major adverse cerebro-cardiac vascular events (MACCE) at 30-days were recorded. Post procedural PVL and mean pressure gradient were also evaluated by transthoracic echocardiography at 30-days.
 
 
 Results:
 Mean aortic annulus area in the S-BSA group was significantly smaller than in the L-BSA group (412.7 ± 70.8 cm2 vs. 498.5 ± 88.8 cm2; p< 0.001) but degree of device oversizing was similar between groups (16.6% vs 17.0%, p=0.74). MACCE were similar between both groups (6.7% vs. 6.1%; p =0.483), however major vascular events were significant higher in S-BSA (15.4% vs. 7.0%; p=0.007). There was one patient with aortic annulus injury in the S-BSA group. Similar post-procedural mean pressure gradient was achieved in both groups (10.2 ± 4.1 mmHg vs. 9.6 ± 3.9 mmHg; p=0.17). S-BSA was significantly associated with the incidence of PVL (PVL ≤mild: 41.6% vs. 23.5%; p<0.001; moderate PVL ≤; 12.1% vs. 5.0%; p=0.009). Post-dilatation was higher in S-BSA (14.8% vs. 7.4%; p=0.017). Multivariate analysis demonstrated that aortic valve calcium was an independent strong predictor of PVL (Odds ratio (OR): 1.002; 95% confidence interval (CI) 1.001-1.003; p=0.001). S-BSA was found to be independently protective for PVL (OR: 0.38; 95% CI 0.24-0.61; p<0.001).
 
 
 Conclusions:
 TAVR in patients with S-BSA was associated with similar MACCE overall but with higher incidence of major vascular events compared to L-BSA. S-BSA was found to be independently protective for post procedural PVL at 30-days in patients that underwent balloon-expandable TAVR. This appeared independent to the degree of oversizing.
