Hellenic Journal of Cardiology (Mar 2023)

Transcatheter aortic valve implantation with different self-expanding devices—a propensity score-matched multicenter comparison

  • Hendrik Wienemann,
  • Alexander Hof,
  • Sebastian Ludwig,
  • Verena Veulemans,
  • Alexander Sedaghat,
  • Christos Iliadis,
  • Max Meertens,
  • Sascha Macherey,
  • Christopher Hohmann,
  • Elmar Kuhn,
  • Baravan Al-Kassou,
  • Nihal Wilde,
  • Niklas Schofer,
  • Sabine Bleiziffer,
  • Oliver Maier,
  • Malte Kelm,
  • Stephan Baldus,
  • Tanja Katharina Rudolph,
  • Matti Adam,
  • Victor Mauri

Journal volume & issue
Vol. 70
pp. 1 – 9

Abstract

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Objective: Several supra-annular self-expanding transcatheter systems are commercially available for transcatheter aortic valve implantation (TAVI). Comparative data in large-scale multicenter studies are scant. Methods: This study included a total of 5175 patients with severe aortic stenosis undergoing TAVI with the ACURATE neo (n = 1095), Evolut R (n = 3365), or Evolut PRO (n = 715) by a transfemoral approach at five high-volume centers. Propensity score matching resulted in 654 triplets. Outcomes are reported according to the Valve Academic Research Consortium-3 (VARC-3) consensus. Results: Moderate or severe paravalvular regurgitation (PVR) occurred significantly more often in the ACURATE neo group (5.2%) than in the Evolut R (1.8%) and Evolut PRO (3.3%) groups (p = 0.003). The rates of major vascular-/access-related complications (4.6%, 3.8%, and 5.0%; p = 0.56), type 3 or 4 bleeding (3.2%, 2.1%, and 4.1%; p = 0.12), and 30-day mortality (2.4%, 2.6%, and 3.7%; p = 0.40) were comparable. The rate of new permanent pacemaker implantation (PPI) was significantly lower in the ACURATE neo group (9.5%, 17.6%, and 16.8%; p < 0.001). Independent predictors for 2-year survival were a Society of Thoracic Surgeons (STS) risk score ≥5%, diabetes mellitus, a glomerular filtration rate <30 ml/min, baseline mean transvalvular gradient ≤ 30 mm Hg, treating center, and relevant PVR. Conclusion: In this multicenter study, TAVI with the ACURATE neo, Evolut R, or Evolut PRO was feasible and safe. The rate of relevant PVR was more frequent after the ACURATE neo implantation, with, however, lower rates of PPI. Two-year survival was mainly driven by baseline comorbidities.

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