Long-Term Results Following Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients with Severe Aortic Stenosis: A Systematic Review and Meta-Analysis of Randomized Trials.

Transcatheter aortic valve replacement (TAVR) is a safe and effective treatment option for patients with severe aortic stenosis at intermediate or high surgical risk. Results after TAVR in low-risk patients are very encouraging at mid-term follow-up while limited long-term (≥ 3-year) data are available in this subset of patients. This meta-analysis aims to compare the long-term follow-up after TAVR versus surgical aortic valve replacement (SAVR) in low-risk patients. We searched databases up to July 7th 2024, for randomized clinical trials (RCTs) comparing TAVR versus SAVR in low-risk patients (defined as STS-PROM Score less than 4%). (PROSPERO ID: CRD42023480495). Primary outcome analysed was all-cause death at minimum 3-year follow-up. Secondary outcomes were: cardiovascular death, disabling stroke, myocardial infarction (MI), aortic valve reintervention, endocarditis, new-onset atrial fibrillation, permanent pacemaker implantation (PPI) and bioprosthetic valve failure (BVF). A total of 3 RCTs with 2,644 patients (TAVR, n=1,371 patients; SAVR, n=1,273 patients) were included. Follow-up time was 6 ± 2.9 years. TAVR resulted non-inferior to SAVR for all-cause death [RR: 0.99 (95% CI: 0.84-1.17; p=0.89; I2=28%)], cardiovascular death [RR: 0.94 (95% CI: 0.76-1.15; p=0.54; I2=0%)], MI [RR: 1.06 (95% CI: 0.71-1.57; p=0.79; I2=61%)], aortic valve reintervention, endocarditis and BVF. New-onset atrial fibrillation was higher in the SAVR group, while PPI in the TAVR group. In conclusion our meta-analysis showed that TAVR is associated with similar long-term outcomes compared to SAVR in selected, low-risk patients.

Comparing two-year outcomes of balloon-expandable Myval and self-expanding Evolut R in severe aortic valve stenosis.

BACKGROUND: The new balloon-expandable (BE) Myval transcatheter heart valves (THV) has shown promising early results with low paravalvular leak (PVL) and permanent pacemaker implantation (PPI) rates. Limited data are available regarding its long-term performance. We aimed to compare the 2-year clinical and echocardiographic outcomes of transcatheter aortic valve replacement (TAVR) using the self-expanding (SE) Evolut R and the BE Myval THVs. METHODS: The EVAL study included 166 patients with severe aortic valve stenosis who underwent TAVR either with SE Evolut R (n = 108) or BE Myval (n = 58) THV. Primary objectives include comparison on clinical efficacy (freedom from all-cause mortality, stroke, and cardiovascular hospitalization), echocardiographic performance and PPI rates between the two THVs. RESULTS: At 2-year the BE Myval group showed higher clinical efficacy (86% vs. 66%,HR:2.62, 95%CI 2.2-5.1;p = 0.006), with fewer cardiac hospitalizations (3.4% vs. 13.9%,p = 0.03). No significant differences in all-cause mortality, cardiovascular mortality, or stroke rates were observed. The proportion of patients with ≥moderate PVL was significantly lower in the BE Myval compared to the SE Evolut R group (4%vs. 22%,p = 0.008). The mean transvalvular gradient was significantly higher in the SE group compared to the BE group (9.5 ± 4.3 vs. 6.9 ± 2.2 mmHg,p < 0.001), however there was no difference in the percentage of patients with a mean gradient ≥20 mmHg between the two groups. CONCLUSIONS: Both THVs offer similar 2-year clinical outcomes. The BE Myval THV demonstrated advantages with higher clinical efficacy and lower PVL incidence. Longer follow-up and randomized trials are needed to validate these results and assess Myval's sustained performance and durability.

Functional magnetic resonance imaging in the evaluation of the elastic properties of ascending aortic aneurysm

Abstract Objective: To evaluate the aortic wall elasticity using the maximal rate of systolic distension (MRSD) and maximal rate of diastolic recoil (MRDR) and their correlation with the aortic size index (ASI). Methods: Forty-eight patients with thoracic aortic aneurysm were enrolled in this study. A standard magnetic resonance imaging (MRI) protocol was used to calculate MRSD and MRDR. Both MRSD and MRDR were expressed as percentile of maximal area/10-3 sec. ASI (maximal aortic diameter/body surface area) was calculated. A correlation between MRSD, MRDR, ASI, and the patient's age was performed using regression plot. Results: A significant correlation between MRSD (t=-4,36; r2=0.29; P≤0.0001), MRDR (t=3.92; r2=0.25; P=0.0003), and ASI (25±4.33 mm/m2; range 15,48-35,14 mm/m2) is observed. As ASI increases, aortic MRSD and MRDR decrease. Such inverse correlation between MRSD, MRDR, and ASI indicates increased stiffness of the ascending aorta. A significant correlation between the patient's age and the decrease in MRSD and MRDR is observed. Conclusion: MRSD and MRDR are significantly correlated with ASI and the patient's age. They seem to describe properly the increasing stiffness of aortas. These two new indexes provide a promising, accessible, and reproducible approach to evaluate the biomechanical property of the aorta.