SPC365

Transcatheter aortic valve design and mortality: truth or reality?

Session: Comunicações Orais (Sessão 7) - Intervenção Cardíaca Coronária e Estrutural 1 - Válvula Aórtica
Speaker: Ana Margarida Martins

Congress: CPC 2022
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.4 Interventional Cardiology - Other
Session Type: Comunicações Orais
FP Number: ---
Authors: Margarida Martins; Pedro Silvério António; Sara Couto Pereira; Pedro Alves da Silva; Beatriz Valente Silva; Joana Brito; Ana Beatriz Garcia; Catarina Oliveira; Fernando Ribeiro; Miguel Nobre Menezes; João Silva Marques; Cláudia Jorge; Pedro Carrilho Ferreira; Fausto j. Pinto; Pedro Cardoso

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Introduction</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">: Third generation transcatheter heart valves have been developed to improve safety of transcatheter aortic valve replacement (TAVR). This study aimed to compare mid-term outcomes after TAVR with Sapien 3 (S3), Sapien 3 Ultra (S3U), Evolut R (EvR) and Evolut Pro (EvP).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Methods</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">: Patients (pts) who underwent TAVR between 2016 and 2020 at a single centre were retrospectively analysed. Primary endpoint was all-cause mortality. Secondary endpoint included peri-procedural results, clinical and echo findings.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Results</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">: A total of 545 pts (S3=181; S3U=83; EvR= 103; EvP=155) were included: 55% female, mean age 82&plusmn;6 years, 91% had hypertension, 74% dyslipidemia, 37% diabetes mellitus, 14% coronary artery disease, 31% chronic kidney disease.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">Mean follow-up (FUP) was 768 &plusmn; 565 days.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">Mean EUROSCORE II was 4.2 &plusmn; 3.6. Pts who implanted 3</span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><sup>rd</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"> generation prosthesis (S3U and EvP) had significantly lower EUROSCORE II compared to those who implanted 2</span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><sup>nd</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"> generation prothesis (S3 and EvR): S3U 3.4&plusmn;1.9, S3 4.4&plusmn;3.9, EvoR 4.8 &plusmn; 3.6 and EvP 3.1&plusmn;3.4, p=0.033. Pre-procedure NYHA was significantly higher in pts with S3 and EvR prosthesis (NYHA III-IV: 70% and 78%) than in pts with S3U and EvP (NYHA III-IV 48% and 54%), p&lt;0.001. Complication rates were similar in all prosthesis, namely major bleeding (3% for S3, EvR, EvP vs 4% for S3U; p=0.992) and ischemic stroke (1% in S3, 3% in S3U and EvP, and 2% in EvR; p=0.592).&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">Conduction disturbances leading to permanent pacemaker implantation after TAVR was of 20%, 22%, 27% and 26% for S3U, S3, EvR and EvP, with no significant differences (p=0.10).&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">As for hemodynamic profile, aortic mean gradient at 24 hours after TAVR compared with 1-year FUP was only significantly increased for S3U (10 vs 14 mmHg, p=0.005), although without clinical impact. No difference was found for ejection fraction for all prosthesis.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">Mortality rate was significantly different between groups (p&lt;0.001): 38%, 12%, 44% and 24% for S3, S3U, EvR and EvP, respectively. Survival analysis is shown in Figure 1 (LogRank 11.5, p=0.009).</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Conclusion</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">: Although last generation prothesis were associated with less mortality in our cohort, we found no differences regarding complication rates between different prosthesis. These findings may suggest that pts&rsquo; comorbidities and functional class may be the main determinants of mortality among them.</span></span></span></p>