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

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

DOI: 10.4244/EIJ-D-18-01120

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 Cardiac Surgery, Cardiovascular Center Bad Neustadt, Bad Neustadt a. d. Saale, Germany
4. Department of Cardiology, Cardiovascular Center Bad Neustadt, Bad Neustadt a. d. Saale, Germany
5. Department of Cardiac Surgery, Cardiovascular Center Bad Neustadt, Bad Neustadt a. d. Saale, Germany
6. Department of Cardiology, Phillipp University of Marburg, Marburg, Germany
7. Department of Cardiology, Zentralklinik Bad Berka, Bad Berka, Germany
8. Department of Cardiology, Zentralklinik Bad Berka, Bad Berka, Germany
9. Department of Cardiac Surgery, Zentralkinik Bad Berka, Bad Berka, Germany
10. Department of Internal Medicine I, Division of Cardiology, University of Giessen, Giessen, Germany
11. Department of Internal Medicine I, Division of Cardiology, University of Giessen, Giessen, Germany
12. Department of Cardiology, Cardiovascular Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany, GERMANY
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Aims: In the absence of randomized data, we aimed to compare the transapical ACURATE and transfemoral ACURATE neo with the SAPIEN 3 prostheses using propensity-matching. 

Methods and results: From 2012 to 2016, 1306 patients at 3 German centers received either the ACURATE/ACURATE neo prostheses (n=591) or the SAPIEN 3 prosthesis (n=715). Through nearest neighborhood matching with exact allocation for access route and center, pairs of 329 patients (250 transfemoral, 79 transapical) per group were determined. Patients were 81 years in average and had a logistic EuroSCORE-I of 19%. Pre- and post-dilatation was more frequent in the ACURATE group (97.6% versus 52.1%, p<0.001 for pre-dilatation and 40.4% versus 11.6%, p<0.001 for post-dilation), but rapid pacing for implantation was used less frequently (37.1% versus 98.2%, p<0.001). More than mild aortic regurgitation at post-operative echocardiography was 12.0% for the ACURATE group and 3.1% for the SAPIEN group, p=<0.001), thereby more than mild aortic regurgitation in the ACURATE group differed amongst the centers with 6.0% (3/50) in center 1, 34.1% (29/85) in center 2 and 3.4% (6/181) in center 3. Patients in the ACURATE group had less pacemaker compared to SAPIEN 3 (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% [84.0–92.2]. 

Conclusions: In this propensity score analysis, patients treated with the transapical ACURATE or transfemoral ACURATE neo prostheses had less pacemakers at 30 days, but more aortic regurgitation and lower 1 year survival.

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