Duk-Woo Park
Asan Medical Center, Republic of Korea At the recent AP VALVES & SH 2024 conference, Dr. Duk-Woo Park from the Asan Medical Center in Seoul highlighted critical considerations for Transcatheter Aortic Valve Replacement (TAVR) in Asian populations, particularly focusing on patients with smaller annuli, vessels, and body sizes. As TAVR becomes increasingly adopted across Asia, the unique anatomical challenges posed by these smaller dimensions demand careful selection of prosthetic valves to optimize patient outcomes.

One of the key concerns discussed was the prevalence of small aortic annuli in the Asian population, which occurs in approximately 40% of cases. This anatomical feature is associated with a higher risk of prosthesis-patient mismatch (PPM), where the implanted valve is too small relative to the patient’s body size. This mismatch can lead to increased mechanical stress on the valve leaflets, accelerating structural valve degeneration and reducing long-term durability—a concern particularly pertinent given the growing emphasis on valve longevity in the region.

The session also underscored the racial disparities in TAVR outcomes, with Asian patients showing a higher incidence of severe PPM compared to their Western counterparts. This difference emphasizes the need for tailored approaches when treating Asian patients. Dr. Park noted that while newer generation valves have improved hemodynamic performance, ensuring an optimal fit remains challenging, particularly for high-risk patients and younger, more active individuals.

Further insights were provided from the SMART trial, which compared self-expanding valves (SEV) and balloon-expandable valves (BEV) in patients with small aortic annuli. The trial, one of the largest and most rigorous to date, revealed that SEVs offered superior valve performance, including a 32.2% lower incidence of bioprosthetic valve dysfunction and a 5.3% reduction in severe PPM. These findings suggest that SEVs may be particularly advantageous for Asian patients, though the direct applicability of the trial’s results to this population remains a subject of ongoing debate.

In conclusion, while advancements in TAVR technology are promising, the conference highlighted the necessity of further research and validation to ensure these innovations translate into improved outcomes for Asian patients with small annuli and other unique anatomical features.

Keynote Lectures on TAVR 2024

Friday, August 09, 1:00 PM ~ 2:00 PM
Main Arena, Vista Hall 1, B2

Check The Session