Aortic valve biologic protheses: A cohort comparison of premature valve failure

Robotic Aortic Valve Replacement vs Transcatheter Aortic Valve Replacement: A Propensity-Matched Analysis

BACKGROUND

Current evidence supports equipoise between surgical aortic valve replacement (AVR) and transcatheter AVR (TAVR) for the management of symptomatic severe aortic stenosis (AS). The optimal interventional management for lower-risk patients is controversial. Minimally invasive robotic AVR (RAVR) was developed as a potential option.

METHODS

A total of 605 consecutive patients (2017-2023) managed by the identical structural heart team, 174 RAVR and 431 TAVR, were propensity matched and evaluated for in-hospital and 1-year outcomes.

RESULTS

There were 288 low- to intermediate-risk (The Society of Thoracic Surgeons predicted risk of mortality <8%) patients matched in 2 well-balanced groups (144 RAVR vs 144 TAVR). In-hospital and 30-day mortality were similar. There were 2 conversions to sternotomy in the TAVR group (cardiac arrest and coronary occlusion) and none in the RAVR group. Eight RAVR patients (5.6%) required reoperation for hemothorax evacuation. TAVR was associated with higher new pacemaker (11 vs 3, P = .028) and major vascular complications (13 vs 0, P < .0001), and a higher postprocedural stroke trend (6 vs 1, P = .056). There was no difference in 30-day transfusions, atrial fibrillation, or 1-year mean valve gradients. However, 1-year mortality (12.5% vs 1.4%, P < .0001) and paravalvular leak greater than mild (32.6% vs 2.3%, P < 0.0001) were significantly higher in TAVR.

CONCLUSIONS

These data highlight lower pacemaker and vascular complications, as well as less 1-year paravalvular leak and mortality with RAVR compared with TAVR. RAVR may provide a safe and effective minimally invasive alternative to TAVR for low- and intermediate-risk patients presenting with severe symptomatic AS.

Real-world outcomes and management considerations following surgical aortic valve replacement with the Trifecta valve

BACKGROUND

Bioprosthetic surgical aortic valve replacement (SAVR) using the Trifecta valve was frequently chosen because of its large opening area and low transvalvular gradient. However, long-term follow-up revealed the potential for early structural valve deterioration. To further assess the long-term clinical outcomes and management considerations for patients implanted with the Trifecta valve, a real-world study using Medicare fee-for-service claims data was conducted with a focus on Trifecta valve reintervention.

METHODS

De-identified patients undergoing SAVR with the Trifecta™ valve (Abbott) in the U.S. between 1/1/2011-12/31/2021 were selected by ICD-9/10 procedure codes and then linked to a manufacturer device tracking database. All-cause mortality and freedom from Trifecta valve reintervention with repeat SAVR or valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) were evaluated at 10-years using the Kaplan Meier method. Independent predictors for reintervention and clinical outcomes following reintervention were assessed.

RESULTS

Among 242,160 Medicare beneficiaries undergoing SAVR during the study period, 23,197 were implanted with the Trifecta valve. Mean age was 75.2 ± 7.4 years. At 10-years survival was 32.3 % (95 % CI, 31.4 %-33.3 %) and the freedom from valve reintervention was 82.4 % (95 % CI, 81.1 %-83.5 %). Independent predictors for reintervention included younger age, female, obesity, and implants with a small valve size (19 mm, 21 mm). Reintervention with ViV-TAVI (N = 796) was associated with better operative survival (3.8 % vs. 12.5 %, p < 0.001) than repeat SAVR (N = 577).

CONCLUSION

This real-world nationwide study of Medicare beneficiaries receiving the Trifecta valve demonstrates >80 % freedom from all-cause valve reintervention at 10-years post-implant with reintervention using ViV-TAVI having improved operative survival compared to repeat SAVR.

Eight-year outcomes of aortic valve replacement with the Carpentier-Edwards PERIMOUNT Magna Ease valve

INTRODUCTION

The Carpentier-Edwards PERIMOUNT Magna Ease valve is a third-generation bioprosthesis for aortic valve replacement (AVR). This is a postapproval study reporting on its 8-year outcomes.

METHODS

Adults undergoing AVR with the Magna Ease valve between October 2007 and December 2012 were enrolled for this prospective, nonrandomized, single-arm, and multicenter study. Assessments occurred preoperatively, at hospital discharge, 6 months, 1 year, and annually thereafter for up to 8 years. Outcomes included safety endpoints, hemodynamic performance, and New York Heart Association (NYHA) functional class.

RESULTS

Of the 258 study patients, 67.5% were in NYHA Class I or II, and 32.5% were in NYHA Class III or IV at baseline. Concomitant procedures were performed in 44.2%. Total follow-up was 1597.6 patient-years, and median follow-up was 7 years (interquartile range: 5.5-8.0 years). Eight years following AVR, the functional class remained improved from baseline with 93.9% in NYHA Class I/II and 6.1% in NYHA Class III; 38 deaths had occurred, 8 of which were valve related; freedom from all-cause mortality was 80.7% (95% confidence intervals: 74.9, 86.4); freedom from valve-related mortality was 95.8% (92.8, 98.8); freedom from reintervention, explant, major bleeding events, and structural valve deterioration was 89.8% (85.1, 94.6), 94.8% (91.7, 97.9), 85.1% (80.0, 90.1), and 90.1% (84.7, 95.4), respectively; effective orifice area was 1.5 ± 0.5 cm² , the mean gradient was 14.8 ± 8.3 mmHg, and 88.6% of patients had no or trivial aortic regurgitation.

CONCLUSIONS

This study demonstrated satisfactory safety and sustained hemodynamic and functional improvements at 8 years following AVR with the Magna Ease valve.