{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T07:27:16Z","timestamp":1791876436810,"version":"4.3.4"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,4,7]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Among patients treated for severe aortic stenosis, a small aortic annulus could have a different impact on outcomes according to body size. We aimed to compare forward\u2010flow hemodynamics and clinical outcomes after transcatheter aortic valve replacement in patients with small annuli according to aortic annular area (AAA) index, defined as computed tomography\u2010derived AAA divided by body surface area.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      The TAVI\u2010SMALL 2 (International Multicenter Registry to Evaluate the Performance of Self\u2010Expandable Valves in Small Aortic Annuli 2) observational, retrospective, international cohort study enrolled patients with severe aortic stenosis and small annuli in 16 high\u2010volume centers between 2011 and 2020. Analyses comparing patients with low (ie, \u22642\u2009cm\n                      <jats:sup>2<\/jats:sup>\n                      \/m\n                      <jats:sup>2<\/jats:sup>\n                      ) and high AAA index (ie, &gt;2\u2009cm\n                      <jats:sup>2<\/jats:sup>\n                      \/m\n                      <jats:sup>2<\/jats:sup>\n                      ) were conducted adopting propensity score methodology. Primary end points were predischarge device forward\u2010flow composite (including mean aortic gradient \u226520\u2009mm\u2009Hg or severe prosthesis\u2013patient mismatch), and clinical efficacy composite (including all\u2010cause death, transient ischemic attack\/stroke, or hospitalization for heart failure) at 1\u2010year follow\u2010up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      A total of 1256 patients were included in the analysis. In the 1:1 propensity score\u2013matched population (n=688), the primary predischarge forward\u2010flow composite end point occurred in 48 patients (7.5%) overall and was more common in low versus high AAA index (9.7% versus 5.3%,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.034). The primary composite clinical efficacy end point occurred in 95 patients (18.1%), and no difference between groups was observed at 1\u2010year follow\u2010up (11.5% [95% CI, 7.8%\u201316.8%] versus 14.4% [95% CI, 10.4%\u201319.9%], hazard ratio, 0.89 [95% CI, 0.59\u20131.33];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      <jats:sub>log\u2010rank<\/jats:sub>\n                      =0.842).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Among patients with small aortic annuli undergoing transcatheter aortic valve replacement, the novel AAA index further identifies patients at increased risk of predischarge suboptimal forward\u2010flow hemodynamics. No difference in clinical efficacy at 1\u2010year follow\u2010up was observed according to the AAA index.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.045483","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T11:07:29Z","timestamp":1773832049000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Simple Index for Identifying Patients at Increased Risk of Suboptimal Forward\u2010Flow Hemodynamics After Transcatheter Aortic Valve Replacement"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0561-4760","authenticated-orcid":false,"given":"Pier Pasquale","family":"Leone","sequence":"first","affiliation":[{"name":"Albert Einstein College of Medicine","place":["Bronx, USA"]},{"name":"White Plains Hospital","place":["White Plains, 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