Outcomes of Fluoroscopy‐Based Asymmetric Underexpansion With the Self‐Expanding ACURATE Neo and Neo2 Valve

Asymmetric underexpansion of transcatheter heart valves (THVs), as observed on fluoroscopy, may influence prosthesis function or long-term durability of transcatheter aortic valve implantation (TAVI). This study aimed to evaluate the effect of stent frame asymmetry on hemodynamic performance and clinical outcomes in ACURATE neo and neo2 THVs. In a retrospective registry, the TAVI asymmetry index was defined as the ratio of the THV stent frame diameter. Patients were divided into three groups based on this ratio: a tubular shape, TAVI asymmetry index < 10% (group 1); a tapered shape, a bottom diameter at least 10% greater than the upper diameter (group 2); and a flared shape, an upper diameter at least 10% greater than the bottom diameter (group 3). Impaired THV hemodynamic performance was defined as a mean residual THV gradient ≥ 20 mmHg and/or at least moderate paravalvular regurgitation. From December 2015 to 2023, 585 patients were included (group 1, n = 447; group 2, n = 96; and group 3, n = 47). Compared to group 1, groups 2 and 3 exhibited a higher incidence of impaired THV hemodynamic performance (4.9% vs. 17.5% vs. 11.9%; p < 0.001). There was no significant difference in all-cause mortality or heart failure hospitalization at 3 years among the three groups (p = 0.787). In multivariable analysis, stent frame asymmetry (groups 2 and 3) was an independent predictor of impaired THV hemodynamic performance. Stent frame asymmetry of ACURATE neo and neo2 was associated with impaired THV hemodynamic performance but not with clinical outcomes.