VIVA Trial: TAVR in Severe AS and Small Annulus

viva trial tavr

The infographic summarizes the VIVA TRIAL as follows:

Year: 2024 Title: VIVA TRIAL Subtitle: Transcatheter or Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis and Small Aortic Annulus Type of Trial: A prospective, randomized, parallel, blinded trial

Objective: To compare the hemodynamic and clinical outcomes between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis and a small aortic annulus (SAA).

Participants: 151

Inclusion Criteria:

  • At least 65 years of age
  • Severe aortic stenosis and small aortic annulus

Exclusion Criteria:

  • Aortic root dilatation (>45 mm)
  • Chronic coronary artery disease not amenable to PCI or coronary artery bypass grafting
  • Concomitant mitral or tricuspid valve disease or previous aortic valve surgery


  • TAVR (n = 77)
  • SAVR (n = 74)

Primary Outcome:

  • Impaired valve hemodynamics (defined as severe prosthesis-patient mismatch or moderate to severe aortic regurgitation) at 60 days %
  • TAVR Group: 5.6%
  • SAVR Group: 10.3%
  • (P = 0.30)

Secondary Outcomes:

  • Mortality at 30 days %
    • TAVR Group: 1.3%
    • SAVR Group: 1.4%
    • (P = 1.00)
  • Stroke at 30 days %
    • TAVR Group: 0%
    • SAVR Group: 2.7%
    • (P = 0.24)

Conclusion: In patients with severe aortic stenosis and SAA (women in the majority), there was no evidence of superiority of contemporary TAVR versus SAVR in valve hemodynamic results. After a median follow-up of 2 years, there were no differences in clinical outcomes between groups.

Reference: Rodés-Cabau J et al. Circulation 2024;149:644-55

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