Won-Keun Kim; Moritz Seiffert; Andreas Rück; David Leistner; Henryk Dreger; Hendrik Wienemann; Matti Adam; Helge Möllmann; Johannes Blumenstein; Clemens Eckel; Andrea Buono; Diego Maffeo; Antonio Messina; Andreas Holzamer; Samuel Sossalla; Giuliano Costa; Marco Barbanti; Silvia Motta; Corrado Tamburino; Ina von der Heide; Julius Glasmacher; Mohammad Sherif; Philipp Seppelt; Stephan Fischtlscherer; Thomas Walther; Fausto Castriota; Roberto Nerla; Christian Frerker; Tobias Schmidt; Alexander Wolf; Martin Adamaszek; Francesco Giannini; Maarten Vanhaverbeke; Stefaan Van de Walle; Francis Stammen; Stefan Toggweiler; Stephanie Brunner; Antonio Mangieri; Mauro Gitto; Gerrit Kaleschke; Vlasis Ninios; Ilias Ninios; Judith Hübner; Erion Xhepa; Matthias Renker; Efstratios Charitos; Michael Joner; Tobias Rheude

doi:10.4244/EIJ-D-23-00779

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

The reference multimedia journal in interventional cardiology

Original Research

DOI: 10.4244/EIJ-D-23-00779

Comparison of two self-expanding transcatheter heart valves for degenerated surgical bioprostheses: the AVENGER multicentre registry

Won-Keun Kim¹^,²^,³, MD, PhD; Moritz Seiffert⁴, MD, PhD; Andreas Rück⁵, MD, PhD; David M. Leistner⁶^,⁷, MD, PhD; Henryk Dreger⁷^,⁸, MD, PhD; Hendrik Wienemann⁹, MD; Matti Adam⁹, MD, PhD; Helge Möllmann¹⁰, MD, PhD; Johannes Blumenstein¹⁰^,¹¹, MD, PhD; Clemens Eckel¹⁰^,¹¹, MD; Andrea Buono¹², MD; Diego Maffeo¹², MD; Antonio Messina¹³, MD; Andreas Holzamer¹⁴, MD; Samuel Sossalla¹^,³, MD, PhD; Giuliano Costa¹⁵, MD; Marco Barbanti¹⁶, MD; Silvia Motta¹⁵, MD; Corrado Tamburino¹⁵, MD; Ina von der Heide⁴, MD; Julius Glasmacher⁷^,⁸, MD; Mohammad Sherif⁷^,⁸, MD, PhD; Philipp Seppelt⁶, MD; Stephan Fichtlscherer⁶, MD, PhD; Thomas Walther⁶, MD, PhD; Fausto Castriota¹⁷, MD; Roberto Nerla¹⁷, MD; Christian Frerker¹⁸, MD, PhD; Tobias Schmidt¹⁸, MD, PhD; Alexander Wolf¹⁹, MD; Martin M. Adamaszek¹⁹, MD; Francesco Giannini²⁰, MD; Maarten Vanhaverbeke²¹, MD, PhD; Stefaan Van de Walle²¹, MD; Francis Stammen²¹, MD, PhD; Stefan Toggweiler²², MD, PhD; Stephanie Brunner²², MD; Antonio Mangieri²³, MD; Mauro Gitto²⁴, MD; Gerrit Kaleschke²⁵, MD; Vlasis Ninios²⁶, MD; Ilias Ninios²⁶, MD; Judith Hübner²⁷, MD; Erion Xhepa²⁷, MD, PhD; Matthias Renker¹^,², MD; Efstratios I. Charitos², MD; Michael Joner²⁷, MD, PhD; Tobias Rheude²⁷, MD, PhD

1. Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany and DZHK (German Centre for Cardiovascular Research), Partner Site Rhein/Main, Germany; 2. Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany; 3. Department of Cardiology, Justus-Liebig University of Gießen, Gießen, Germany; 4. Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany and DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany; 5. Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; 6. University Heart & Vascular Center Frankfurt, Frankfurt, Germany and DZHK (German Centre for Cardiovascular Research), Partner Site Rhein/Main, Germany; 7. Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany; 8. Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; 9. Clinic III for Internal Medicine, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; 10. Department of Cardiology, St. Johannes-Hospital, Dortmund, Germany; 11. Department of Cardiology, Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany; 12. Cardiovascular Department, Interventional Cardiology Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy; 13. Department of Cardiothoracic Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy and Operative Unit of Cardiac Surgery, Poliambulanza Foundation Ospital, Brescia, Italy; 14. University Hospital of Regensburg, Medical Center, Regensburg, Germany; 15. Division of Cardiology, AOU Policlinico G. Rodolico-San Marco, Catania, Italy; 16. Università degli Studi Di Enna "Kore", Enna, Italy; 17. Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy; 18. Department of Cardiology, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany and DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany; 19. Contilia Herz- und Gefäßzentrum, Elisabeth-Krankenhaus Essen, Essen, Germany; 20. IRCCS Galeazzi Sant’Ambrogio Hospital, Milan, Italy; 21. Department of Cardiology, AZ Delta, Roeselare, Belgium; 22. Heart Center Lucerne, Lucerner Kantonsspital, Lucerne, Switzerland; 23. Cardiocenter, IRCCS, Humanitas Research Hospital, Rozzano, Milan, Italy; 24. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy and IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy; 25. Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Münster, Germany; 26. Interbalkan European Medical Center, Thessaloniki, Greece; 27. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Germany

Abstract

BACKGROUND: There is a lack of comparative data on transcatheter aortic valve implantation (TAVI) in degenerated surgical prostheses (valve-in-valve [ViV]).

AIMS: We sought to compare outcomes of using two self-expanding transcatheter heart valve (THV) systems for ViV.

METHODS: In this retrospective multicentre registry, we included consecutive patients undergoing transfemoral ViV using either the ACURATE neo/neo2 (ACURATE group) or the Evolut R/PRO/PRO+ (EVOLUT group). The primary outcome measure was technical success according to Valve Academic Research Consortium (VARC)-3. Secondary outcomes were 30-day all-cause mortality, device success (VARC-3), coronary obstruction (CO) requiring intervention, rates of severe prosthesis-patient mismatch (PPM), and aortic regurgitation (AR) ≥moderate. Comparisons were made after 1:1 propensity score matching.

RESULTS: The study cohort comprised 835 patients from 20 centres (ACURATE n=251; EVOLUT n=584). In the matched cohort (n=468), technical success (ACURATE 92.7% vs EVOLUT 88.9%; p=0.20) and device success (69.7% vs 73.9%; p=0.36) as well as 30-day mortality (2.8% vs 1.6%; p=0.392) were similar between the two groups. The mean gradients and rates of severe PPM, AR ≥moderate, or CO did not differ between the groups. Technical and device success were higher for the ACURATE platform among patients with a true inner diameter (ID) >19 mm, whereas a true ID ≤19 mm was associated with higher device success − but not technical success − among Evolut recipients.

CONCLUSIONS: ViV TAVI using either ACURATE or Evolut THVs showed similar procedural outcomes. However, a true ID >19 mm was associated with higher device success among ACURATE recipients, whereas in patients with a true ID ≤19 mm, device success was higher when using Evolut.

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