Background: Precise implantation could play a crucial role in the technical success of transcatheter aortic valve replacement (TAVR) for some prostheses. The impact of an implantation depth (ID) outside the recommended range has not been assessed for the ACURATE neo2 (NEO2).
Methods: Data from 1835 patients with severe native aortic stenosis treated with the NEO2 prosthesis between 12/2016 and 07/2023 were evaluated. We compared the results of prostheses implanted both in and outside the recommendations. Outcome assessment followed the Valve Academic Research Consortium-3 criteria.
Results: Patients were divided into high (<3 mm; n=412), optimal (3-7 mm; n=1236), and low (>7 mm; n=169) implantation. Technical success (94.7% vs. 94.7% vs 91.7%, p=0.285) and device success were high (90.1% vs. 89.3% vs. 84.6%, p=0.141) without differences between groups. Hemodynamics were superior in the high-implantation group, with greater iEOA (1.01 cm2/m2 vs. 0.95 cm2/m2 vs. 0.92 cm2/m2, p<0.001). Rates of relevant paravalvular regurgitation (PVL; >mild or VinV due to PVL) were comparable (1.2% vs. 1.8% vs. 1.2%, p=0.758). There was a higher rate of associated pacemaker implantation (PPI) (6.1% vs. 8.8% vs. 14.8%, p=0.005) in the low-implantation group.
Conclusion: Implantation with the SE ACURATE neo2 showed excellent hemodynamic results, including single-digit gradients and low rates of relevant PVL, in line with a high technical success rate that was irrespective of the ID. Even though a high implantation of the prosthesis revealed better hemodynamics with respect to EOA and PPM, and low implantations were associated with a higher incidence of PPI a standard high implantation of the ACURATE neo2 is not necessary.
