Background: There is lack of comparative data on transcatheter aortic valve implantation (TAVI) in degenerated surgical prostheses (ViV).
Objectives: We sought to compare outcomes using two self-expanding transcatheter heart valve (THV) systems for ViV.
Methods: In this multicentre registry, we included consecutive patients undergoing transfemoral ViV using either the ACURATE neo/neo2 (ACURATE group) or EVOLUT R/PRO/PRO+ (EVOLUT group). The primary outcome measure was VARC-3 defined technical success. Secondary outcomes were 30-day all-cause mortality, VARC-3 defined device success, coronary obstruction (CO) requiring intervention, rates of severe prosthesis-patient mismatch (PPM) or ≥moderate aortic regurgitation (AR). Comparisons were made after 1:1 propensity score matching.
Results: The study cohort comprised 835 patients from 20 centers (ACURATE n=251; EVOLUT n=584). In the matched cohort (n=468), technical success (ACURATE 92.7% vs. EVOLUT 88.9%; p=0.20) and device success (69.7% vs. 73.9%; p=0.36) as well as 30-day mortality (2.8% vs. 1.6%; p=0.392) were similar in both groups. Mean transvalvular gradients and rates of severe PPM, ≥moderate AR, and CO did not differ between the groups. Technical and device success were higher for the ACURATE platform among patients with true ID >19 mm, whereas a true ID ≤19 mm was associated with higher device success - but not technical success - among EVOLUT recipients.
Conclusion: ViV TAVI using either ACURATE or EVOLUT THV platforms showed similar procedural outcomes. However, a true ID >19 mm was associated with higher device success among ACURATE recipients, whereas in patients with true ID ≤19 mm device success was higher when using EVOLUT.
