TCT-226 Aspirin Versus Clopidogrel Following Transcatheter Aortic Valve Replacement: A TVT Registry Propensity Matched Analysis

METHODS Patients who underwent MViV with balloon-expandable valves at Mayo Clinic Rochester between 2014 and 2023 were retrospectively analyzed. THV expansion (inflow, waist, outtlow) was measured from procedural fluoroscopy and indexed to nominal size, with zero indicating expansion to nominal dimensions. Median index values were used as subgroup cutoffs to compare incidence of the primary composite outcome of all cause mortality and heart failure reassiols.

RESULTS The analysis included 80 patients with a median follow-up of 2.5 years. The majority of valves were underexpanded, with me. dian inflow, waist, and outflow expansion indices of -10.2, -16.2, and •3.2, respectively. THV expansion closer to nominal size was associated with lower incidence of the primary outcome across all indices (pco.05), except a borderline effect for waist expansion (p=0.064). Greater expansion inversely correlated with transvalvular mean gradient. Oversized valves were more prone to underexpansion, and had higher transvalvular gradients and primary outcome rates compared to recommended-size THVs (p=0.029).

CONCLUSION THV underexpansion degenerated mitral bio-prostheses is common, associated with elevated gradients and worse midterm outcomes. Based on these findings, we propose size-specific minimum TV expansion targets that require exteral validation. Further research into strategies to improve THV expansion is warranted to improve midterm outcomes.