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Kalogeras K, Jabbour RJ, Pracon R, Kabir T, Shannon J, Duncan A, Quarto C, Heng EL, Rahbi H, Oikonomou E, Katsianos E, Patel N, Chandra N, Vavuranakis MA, Cadiz S, Bougiakli M, Smith RD, Siasos G, Vavuranakis M, Davies S, Dalby M, Panoulas V. Midterm Outcomes in Patients With Aortic Stenosis Treated With Contemporary Balloon-Expandable and Self-Expanding Valves: Does Valve Size Have an Impact on Outcome? J Am Heart Assoc 2023:e028038. [PMID: 37232270 PMCID: PMC10382012 DOI: 10.1161/jaha.122.028038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Background No data currently exist comparing the contemporary iterations of balloon-expandable (BE) Edwards SAPIEN 3/Ultra and the self-expanding (SE) Medtronic Evolut PRO/R34 valves. The aim of the study was the comparison of these transcatheter heart valves with emphasis on patients with small aortic annulus. Methods and Results In this retrospective registry, periprocedural outcomes and midterm all-cause mortality were analyzed. A total of 1673 patients (917 SE versus 756 BE) were followed up for a median of 15 months. A total of 194 patients died (11.6%) during follow-up. SE and BE groups showed similar survival at 1 (92.6% versus 90.6%) and 3 (80.3% versus 85.2%) years (Plog-rank=0.136). Compared with the BE group, patients treated with the SE device had lower peak (16.3±8 mm Hg SE versus 21.9±8 mm Hg BE) and mean (8.8±5 mm Hg SE versus 11.5±5 mm Hg BE) gradients at discharge. Conversely, the BE group demonstrated lower rates of at least moderate paravalvular regurgitation postoperatively (5.6% versus 0.7% for SE and BE valves, respectively; P<0.001). In patients treated with small transcatheter heart valves (≤26 mm for SE and ≤23 mm for BE; N=284 for SE and N=260 for BE), survival was higher among patients treated with SE valves at both 1 (96.7% SE versus 92.1% BE) and 3 (91.8% SE versus 82.2% BE) years (Plog-rank=0.042). In propensity-matched patients treated with small transcatheter heart valve, there remained a trend for higher survival among the SE group at both 1 (97% SE versus 92.3% BE) and 3 years (91.8% SE versus 78.7% BE), Plog-rank=0.096). Conclusions Real-world comparison of the latest-generation SE and BE devices demonstrated similar survival up to 3 years' follow-up. In patients with small transcatheter heart valves, there may be a trend for improved survival among those treated with SE valves.
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Affiliation(s)
- Konstantinos Kalogeras
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
- 3rd Department of Cardiology, Sotiria Hospital, Medical School National and Kapodistrian University of Athens Athens Greece
| | - Richard J Jabbour
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
- Cardiovascular Sciences, National Heart and Lung Institute Imperial College London London UK
| | - Radoslaw Pracon
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Tito Kabir
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Joanne Shannon
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Alison Duncan
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Cesare Quarto
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Ee-Ling Heng
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Hazim Rahbi
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, Sotiria Hospital, Medical School National and Kapodistrian University of Athens Athens Greece
| | - Efstratios Katsianos
- 3rd Department of Cardiology, Sotiria Hospital, Medical School National and Kapodistrian University of Athens Athens Greece
| | - Niket Patel
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Navin Chandra
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Michael-Andrew Vavuranakis
- 3rd Department of Cardiology, Sotiria Hospital, Medical School National and Kapodistrian University of Athens Athens Greece
| | - Suzane Cadiz
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Maria Bougiakli
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Robert D Smith
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Gerasimos Siasos
- 3rd Department of Cardiology, Sotiria Hospital, Medical School National and Kapodistrian University of Athens Athens Greece
| | - Manolis Vavuranakis
- 3rd Department of Cardiology, Sotiria Hospital, Medical School National and Kapodistrian University of Athens Athens Greece
| | - Simon Davies
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Miles Dalby
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Vasileios Panoulas
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
- Cardiovascular Sciences, National Heart and Lung Institute Imperial College London London UK
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