1Deutsches Herzzentrum München Klinik für Herz- und Kreislauferkrankungen München, Deutschland; 2Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie Hamburg, Deutschland; 3Universitätsklinikum Frankfurt Med. Klinik III - Kardiologie, Angiologie Frankfurt am Main, Deutschland; 4Deutsches Herzzentrum der Charite (DHZC) Klinik für Kardiologie, Angiologie und Intensivmedizin | CBF Berlin, Deutschland; 5Herzzentrum der Universität zu Köln Klinik III für Innere Medizin Köln, Deutschland; 6Kath. St. Paulus Gesellschaft Klinik für Innere Medizin I Dortmund, Deutschland; 7Universitätsklinikum Regensburg Regensburg, Deutschland; 8Universitätsklinikum Gießen und Marburg GmbH Medizinische Klinik I - Kardiologie und Angiologie Gießen, Deutschland; 9Charité - Universitätsmedizin Berlin CC 11: Med. Klinik für Kardiologie Berlin, Deutschland; 10Universitätsklinikum Frankfurt Klinik für Thorax-, Herz- und Thorakale Gefäßchirurgie Frankfurt am Main, Deutschland; 11Universitätsklinikum Schleswig-Holstein Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin Lübeck, Deutschland; 12Elisabeth-Krankenhaus Essen GmbH Klinik für Kardiologie und Angiologie Essen, Deutschland; 13Universitätsklinikum Münster Klinik für Kardiologie III: Angeborene Herzfehler (EMAH) und Klappenerkrankungen Münster, Deutschland; 14Kerckhoff Klinik GmbH Abteilung für Kardiologie Bad Nauheim, Deutschland; 15Kerckhoff Klinik GmbH Herzchirurgie Bad Nauheim, Deutschland
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.