# Propensity score analysis of stented versus rapid deployment aortic bioprostheses in patients with small aortic annulus

## TL;DR

This study compares rapid deployment aortic valves with conventional stented valves in patients with small aortic annuli, finding better hemodynamic performance with rapid deployment valves but similar survival and complication rates.

## Contribution

The study provides new evidence on hemodynamic benefits of rapid deployment valves in small aortic annulus patients without increased risk of complications.

## Key findings

- Rapid deployment valves showed significantly lower pressure gradients compared to conventional stented valves.
- Mid-term survival and rehospitalization rates were similar between the two valve types.
- No significant differences in postoperative complications were observed between the two groups.

## Abstract

Haemodynamic studies have demonstrated the excellent performance of rapid deployment (RD) valves. This retrospective single-centre study aimed to compare early and medium-term outcomes of RD bioprostheses versus conventional stented valves in patients with small aortic annuli.

We included patients who underwent isolated or combined surgical aortic valve replacement (SAVR) with Magna Ease (ME) and Intuity (Edwards Lifesciences, Irvine, CA) sizes 19 and 21 at our institution between June 2016 and March 2022. Follow-up was conducted through scheduled visits and echocardiograms at the study site, or via telephonic interviews with patients and/or referring cardiologists. A propensity score weighting analysis was performed to account for baseline differences between the 2 cohorts.

A total of 666 consecutive patients underwent SAVR with the 2 devices. ME was implanted in 367 patients (55.1%) and Intuity in 299 (44.9%). ME size 19 or 21 was used in 105 patients (35.1%), and Intuity size 19 or 21 in 115 patients (31.3%). Our study population comprised 220 patients. There were no significant differences in postoperative complications. Intuity demonstrated significantly lower gradients overall (mean gradients: 12 mmHg vs 16 mmHg, P < 0.001) and for size 21 (mean gradients: 12 mmHg vs 15 mmHg, P < 0.001). Mid-term survival and rehospitalization rates were similar between the 2 devices (5-year rehospitalization rate: 17% ME vs 20.9% Intuity, P = 0.57; 5-year survival: 81.9% ME vs 88% Intuity, P = 0.761).

In patients with small aortic annuli, RD bioprostheses provide superior haemodynamic outcomes compared to conventional stented valves. However, perioperative outcomes, mid-term survival, and rehospitalization rates are similar between the 2 devices.

Patients with small aortic annulus face higher risk of patient-prosthesis mismatch (PPM) which worsens clinical and haemodynamic outcomes.