Valve-in-valve procedures using the Portico THV for degenerated surgical aortic bioprostheses achieved 98.3% procedural success, with a 22.1% rate of death, stroke, or HF hospitalization at 1 year.
Observational (n=117)
No
Does the Portico transcatheter heart valve improve procedural and mid-term clinical outcomes in patients with degenerated surgical aortic bioprostheses?
The Portico THV is a safe and effective option for aortic valve-in-valve procedures with favorable hemodynamic performance, though device success is limited by residual gradients in some patients.
Abstract Introduction In the treatment of aortic native valve stenosis, the PORTICO self-expanding transcatheter heart valve (THV) showed similar hemodynamic performance to the Evolut platform. On the other hand, being intra-annular, it is not frequently used in the setting of valve-in-valve (VIV) for a degenerated surgical aortic bioprosthesis. As a consequence, very limited data are available. This study sought to evaluate the procedural and mid-term outcomes of aortic ViV procedures using the Portico THV. Methods we included 117 consecutive patients with a degenerated surgical aortic valve bioprosthesis undergoing VIV with the Portico THV between January 2016 and December 2024 in a high-volume center. VARC-3 definitions were applied. Results The majority of the patients (59, 51%) had a stented bioprosthesis with externally mounted pericardial leaflets. The primary failure mode was stenosis (56, 50%), followed by regurgitation (29, 25%) and mixed etiology (28, 25%). In 82% of the cases, there was a small surgical valve (size ≤ 23 mm). Median time to surgical valve failure was 9 years (IQR 7-12). In 87 cases (74.4%) a 23-mm Portico THV was used. Procedural success was achieved in 98.3% of patients. Device success was 63.2%, primarily limited by residual mean gradient ≥ 20 mmHg (33, 28.7%) and moderate-or-worse paravalvular leak (9, 7.8%). Prosthesis–patient mismatch (PPM) was severe in 10 patients (10.8%): a surgical valve size ≤ 21 mm was an independent predictor of severe PPM at multivariable analysis. At 1-year follow-up: the composite of all-cause death, stroke and HF Hospitalization occurred in 22.1%; NYHA functional class at 1-year improved significantly, with 96% of patients in class I-II; most patients showed none or trivial PVL (N= 74, 63.8%; p 0.134), while mean gradient and AVA remained substantially equal to post procedure. Conclusions the Portico THV appears to be a safe and effective option in the context of TAVI-VIV. Itshemodynamic performance appears to be very favorable, despite its intra-annular position.
Criscione et al. (Sun,) conducted a observational in Degenerated surgical aortic bioprosthesis (n=117). Portico self-expanding transcatheter heart valve (THV) was evaluated on Procedural success. Valve-in-valve procedures using the Portico THV for degenerated surgical aortic bioprostheses achieved 98.3% procedural success, with a 22.1% rate of death, stroke, or HF hospitalization at 1 year.