{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T23:33:28Z","timestamp":1780097608145,"version":"3.54.0"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) provides an alternative treatment for high-risk patients with failed surgical bioprosthetic aortic valves. However, limited data exist on ViV-TAVR outcomes in patients with small aortic annuli, particularly among the relatively small-statured Japanese population.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>We analyzed data from the J-TVT (Japan Transcatheter Valve Therapy) registry, which included all TAVR institutions across Japan, with data collected from July 2018, when ViV-TAVR was approved, through December 2022. A small aortic annulus was defined as an aortic annulus area of \u2264314 mm\u00b2, measured using preoperative computed tomography for ViV-TAVR. Prosthesis-patient mismatch (PPM) was defined as an indexed effective orifice area &lt;0.85 cm\u00b2\/m\u00b2, assessed using echocardiography within 30 days after ViV-TAVR. The composite end point was evaluated at 30 days and 1 year.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              Among 47\u2009800 individuals, 1029 underwent ViV-TAVR, resulting in a final sample of 405 patients. The mean indexed effective orifice area was 0.83 cm\u00b2\/m\u00b2 in the small annulus group (n=225) and 0.94 cm\u00b2\/m\u00b2 in the nonsmall group (n=180), with PPM rates of 59.2% and 44.4%, respectively. Small annuli were independently associated with PPM (odds ratio, 1.9 [95% CI, 1.26\u20132.87];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.002). No differences in 30-day and 1-year outcomes were observed between groups. Among the 225 patients with small annuli, the mean indexed effective orifice area was 0.76 cm\n              <jats:sup>2<\/jats:sup>\n              \/m\n              <jats:sup>2<\/jats:sup>\n              in the balloon-expandable valve group (n=61) and 0.86 cm\n              <jats:sup>2<\/jats:sup>\n              \/m\n              <jats:sup>2<\/jats:sup>\n              in the supraannular self-expanding valve group (n=164), with PPM rates of 67.2% and 56.1%, respectively. No differences in outcomes were noted based on the type of valve implanted.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>ViV-TAVR for small aortic annuli in Japanese patients was associated with an increased risk of PPM; however, no differences in clinical outcomes were observed according to aortic annulus size or valve type. Due to the small size of our sample, further research is required to validate these findings.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circinterventions.124.015087","type":"journal-article","created":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T02:30:13Z","timestamp":1747794613000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Valve-in-Valve TAVR for Degenerated Surgical Valves in Patients With Small Aortic Annuli: A Report From a Japanese Nationwide Registry"],"prefix":"10.1161","volume":"18","author":[{"given":"Yusuke","family":"Oba","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Internal Medicine (Y. Oba, S.H., M.S., H. Kobayashi, H.F., K.H., K. Kario), Jichi Medical University School of Medicine, Tochigi, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiraku","family":"Kumamaru","sequence":"additional","affiliation":[{"name":"Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Japan (H. Kumamaru)."},{"name":"Department of Healthcare Quality Assessment, University of Tokyo Graduate School of Medicine, Japan (H. Kumamaru)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7541-5751","authenticated-orcid":true,"given":"Satoshi","family":"Hoshide","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Internal Medicine (Y. Oba, S.H., M.S., H. Kobayashi, H.F., K.H., K. Kario), Jichi Medical University School of Medicine, Tochigi, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3779-2972","authenticated-orcid":true,"given":"Shun","family":"Kohsaka","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1481-0795","authenticated-orcid":true,"given":"Kazuo","family":"Shimamura","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, The University of Osaka Graduate School of Medicine, Suita, Japan (K.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4203-7613","authenticated-orcid":true,"given":"Yohei","family":"Ohno","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan (Y. Ohno)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masafumi","family":"Sato","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Internal Medicine (Y. Oba, S.H., M.S., H. Kobayashi, H.F., K.H., K. Kario), Jichi Medical University School of Medicine, Tochigi, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8367-921X","authenticated-orcid":true,"given":"Hisaya","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Internal Medicine (Y. Oba, S.H., M.S., H. Kobayashi, H.F., K.H., K. Kario), Jichi Medical University School of Medicine, Tochigi, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Funayama","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Internal Medicine (Y. Oba, S.H., M.S., H. 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