Outcomes after implantation of the ACURATE neo and Portico transcatheter heart valves for the treatment of severe aortic stenosis

Introduction: Among others the ACURATE neo and the Portico self-expanding transcatheter heart valves are widely used to treat severe aortic stenosis. So far, a direct comparison of the hemodynamics of these two valves is lacking. We want to fill this gap by a retrospective analysis of hemodynamic performance and the occurrence of new conduction disturbances.

Methods and results: Prospectively collected data at the University Hospital Zurich and the Heart Center Lucerne between December 2012 and April 2018 were analyzed. A total of 318 consecutive patients undergoing implantation of an ACURATE neo or a Portico valve formed the study population. The ACURATE neo was implanted in 144 patients (44% male) and the Portico in 174 patients (47% male). Patients receiving the ACURATE neo were older (82 ± 6 vs. 80 ± 7, p=0.03), had a higher LVEF (58 ± 12% vs. 54 ± 14%, p= 0.01) and a higher mean transvalvular pressure gradient at baseline (49 ± 17 vs. 41 ± 17 mmHg, p<0.001). There was no difference in annular size between the two groups (a perimeter of 75.3 ± 8.6 vs. 75.4 ± 5.2 mm, p=0.94).

Incidence of > mild paravalvular leak was low in both groups (3.4% in Portico vs. 5.6 % in ACURATE neo, p=0.42) at 30 days. The mean transvalvular pressure gradient after implantation of ACURATE neo was comparable to Portico (7 ± 4 mmHg vs. 8 ± 4 mmHg, p=0.05). New pacemaker insertion was significantly less frequent in the ACURATE neo group (2.5% vs. 10.9%, p=0.01).

Conclusion: Hemodynamic outcomes between the intra-annular Portico and the supra-annular ACURATE neo valve were similar with low transvalvular pressure gradients observed after implantation of both valves. Pacemaker rates after ACURATE neo implantation was lower

Author(s):

Lukas S. Keller, Stefan Toggweiler, Claudia Sütsch, Slayman Obeid, Felix C. Tanner, Miriam Brinkert, Lucca Loretz, Florim Cuculi, Richard Kobza, Frank Ruschitzka, Fabian Nietlispach.

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