Aortic valve interventions

Multicentre propensity-matched comparison of transcatheter aortic valve implantation using the ACURATE TA/neo self-expanding versus the SAPIEN 3 balloon-expandable prosthesis

EuroIntervention 2019;15:884-891. DOI: 10.4244/EIJ-D-18-01120

Sebastian Barth
Sebastian Barth1, MD; Wilko Reents2, MD; Michael Zacher2, MD, MSc; Sebastian Kerber1, MD; Anno Diegeler2, MD; Bernhard Schieffer3, MD; Matthias Schreiber4, MD; Bernward Lauer4, MD; Thomas Kuntze5, MD; Marko Dahmer6, MD; Christian Hamm6, MD; Karsten Hamm1, MD
1. Department of Cardiology, Cardiovascular Center Bad Neustadt, Bad Neustadt a. d. Saale, Germany; 2. Department of Cardiac Surgery, Cardiovascular Center Bad Neustadt, Bad Neustadt a. d. Saale, Germany; 3. Department of Cardiology, Phillipp University of Marburg, Marburg, Germany; 4. Department of Cardiology, Zentralklinik Bad Berka, Bad Berka, Germany; 5. Department of Cardiac Surgery, Zentralkinik Bad Berka, Bad Berka, Germany; 6. Department of Internal Medicine I, Division of Cardiology, University of Giessen, Giessen, Germany

Aims: In the absence of randomised data, we aimed to compare the transapical ACURATE and transfemoral ACURATE neo with the SAPIEN 3 prosthesis using propensity matching.

Methods and results: From 2012 to 2016, 1,306 patients at three German centres received either the ACURATE/ACURATE neo prosthesis (n=591) or the SAPIEN 3 prosthesis (n=715). Through nearest neighbour matching with exact allocation for access route and centre, pairs of 329 patients (250 transfemoral, 79 transapical) per group were determined. Patients were 81 years old on average and had a logistic EuroSCORE I of 19%. Predilatation and post-dilatation were more frequent in the ACURATE group (97.6% versus 52.1%, p<0.001 for predilatation and 40.4% versus 11.6%, p<0.001 for post-dilatation), but rapid pacing for implantation was used less frequently (37.1% versus 98.2%, p<0.001). More-than-mild aortic regurgitation at postoperative echocardiography was 12.0% for the ACURATE group and 3.1% for the SAPIEN group, p≤0.001). More-than-mild aortic regurgitation in the ACURATE group differed amongst the centres with 6.0% (3/50) in centre A, 34.1% (29/85) in centre B and 3.4% (6/181) in centre C. Patients in the ACURATE group less frequently had pacemaker implantation compared to the SAPIEN 3 group (11.9% versus 18.5%, p=0.020), 30-day mortality was 4.6% versus 2.1%, respectively, p=0.134, and one-year survival was 83.1% (95% CI: 77.6-87.4) versus 88.8% (95% CI: 84.0-92.2).

Conclusions: In this propensity score analysis, patients treated with the transapical ACURATE or transfemoral ACURATE neo prosthesis less frequently had pacemakers at 30 days but had more aortic regurgitation and lower one-year survival.

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Interventions for valvular diseaseTAVI
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