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Impact of implantation depth on peri-procedural outcomes after implantation  with the self-expanding ACURATE neo2

https://doi.org/10.1007/s00392-024-02406-5

Sophie Bargon (Dortmund)1, C. Eckel (Dortmund)1, W.-K. Kim (Bad Nauheim)2, J. Schlüter (Dortmund)1, Y.-H. Choi (Bad Nauheim)3, M. Renker (Bad Nauheim)2, S. T. Sossalla (Gießen)4, C. Grothusen (Dortmund)1, A. Elsässer (Oldenburg)5, G. Dohmen (Dortmund)6, E. I. Charitos (Bad Nauheim)3, J. Blumenstein (Dortmund)1, H. Möllmann (Dortmund)1

1Kath. St. Paulus Gesellschaft Klinik für Innere Medizin I Dortmund, Deutschland; 2Kerckhoff Klinik GmbH Abteilung für Kardiologie Bad Nauheim, Deutschland; 3Kerckhoff Klinik GmbH Herzchirurgie Bad Nauheim, Deutschland; 4Universitätsklinikum Gießen und Marburg GmbH Medizinische Klinik I - Kardiologie und Angiologie Gießen, Deutschland; 5Klinikum Oldenburg AöR Klinik für Kardiologie Oldenburg, Deutschland; 6Kath. St. Paulus Gesellschaft Klinik für Herz-, Thorax- und Gefäßchirurgie Dortmund, Deutschland

 

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.

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