The 20 mm SAPIEN 3 valve resulted in higher echocardiographic gradients and severe prosthesis-patient mismatch compared to larger valves, but 1-year all-cause mortality was similar (13.0% vs 12.7%; p=0.72).
Observational (n=7,862)
Sí
Does transfemoral implantation of 20 mm SAPIEN 3 valves increase 1-year all-cause mortality compared to larger (≥23 mm) valves in patients with native aortic valve stenosis?
The use of 20 mm SAPIEN 3 valves in TAVR yields comparable 1-year mortality to larger valves, despite higher rates of severe prosthesis-patient mismatch and elevated discharge gradients.
Tasa de eventos absoluta: 13% vs 12.7%
valor p: p=0.72
OBJECTIVE/BACKGROUND: Small balloon expandable valves have higher echocardiographic transvalvular gradients and rates of prosthesis-patient mismatch (PPM) compared to larger valves. However, the impact of these echocardiographic findings on clinical outcomes is unknown. We sought to determine the clinical outcomes of 20 mm SAPIEN 3 (S3 BEV) compared to larger S3 BEV in relation to echocardiographic hemodynamics. METHODS: Using the STS/ACC transcatheter valve registry, we performed a propensity-matched comparison of patients undergoing treatment of native aortic valve stenosis using transfemoral, balloon-expandable implantation of 20 mm and ≥ 23 mm S3 BEVs. Baseline and procedure characteristics, echocardiographic variables and survival were analyzed. Multivariable logistic regression was used to identify predictors of 1-year mortality. RESULTS: After propensity matching of the 20 mm and ≥ 23 mm SAPIEN 3 valves, 3,931 pairs with comparable baseline characteristics were identified. Small valves were associated with significantly higher echocardiographic gradients at discharge (15.7 ± 7.1 mmHg vs. 11.7 ± 5.5 mmHg, p 20 mmHg), severe PPM and the use of 20 mm versus ≥23 mm were not independent predictors of 1-year mortality. CONCLUSION: SAPIEN 3 20 mm valves were associated with higher echocardiographic gradients, and severe PPM rates compared to larger valves but these factors were not associated with significant differences in 1-year all-cause mortality or rehospitalization.
Eng et al. (Thu,) conducted a observational in Native aortic valve stenosis (n=7,862). 20 mm SAPIEN 3 valve vs. ≥ 23 mm SAPIEN 3 valves was evaluated on 1-year all-cause mortality (p=0.72). The 20 mm SAPIEN 3 valve resulted in higher echocardiographic gradients and severe prosthesis-patient mismatch compared to larger valves, but 1-year all-cause mortality was similar (13.0% vs 12.7%; p=0.72).
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