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Comparison of the Hemodynamic Performance of the Balloon-expandable SAPIEN 3 Versus Self-expandable Evolut R Transcatheter Valve: A Case-matched Study

2017; Elsevier BV; Volume: 71; Issue: 9 Linguagem: Inglês

10.1016/j.rec.2017.10.025

1885-5857

Luis Eduardo Enríquez Rodríguez, Ignacio J. Amat‐Santos, Pilar Jiménez‐Quevedo, Irene Martín-Morquecho, Gabriela Tirado‐Conte, Marı́a José Pérez-Vizcayno, José Juan Gómez de Diego, Román Arnold, Andrés Aldazábal, Paol Rojas, José Agustín, María Del Trigo, Hipólito Gutiérrez, José Alberto San Román, Carlos Macaya, Luis Nombela‐Franco,

Aortic Disease and Treatment Approaches

The SAPIEN 3 (S3) valve and the Medtronic Evolut R (EVR) are second-generation transcatheter valves, designed to further reduce the rate of paravalvular aortic regurgitation (AoR). The aim of this study was to compare the 2 devices in terms of valve performance in a case-matched study with independent echocardiographic analysis.Of a population of 201 patients who underwent transcatheter aortic valve implantation, 144 patients (S3, n = 80; EVR, n = 64) were matched according to aortic annulus diameter and aortic valve calcium score, as assessed by computed tomography. All echocardiographic examinations collected at baseline and at 1- and 6-month follow-up were centrally analyzed.The 2 groups were well balanced in baseline clinical and echocardiographic characteristics. The EVR valve showed a better hemodynamic profile as assessed by peak aortic gradient (EVR 13 ± 7 vs S3 20 ± 10mmHg; P<.001), mean aortic gradient (EVR 7 ± 3 vs S3 11 ± 6mmHg; P<.001), and Doppler velocity index (EVR 0.65±0.15 vs S3 0.51±0.16; P<.001). The rate of moderate-severe or any paravalvular (≥ mild) AoR was higher in the EVR group (11% and 50%) than in the S3 group (2.5% and 21%; P <.05, respectively), with a larger number of paravalvular jets (P <.001).In a case-matched cohort of transcatheter aortic valve implantation patients, the S3 valve was associated with a lower rate of paravalvular AoR but also with a higher residual gradient than the EVR system.