Key result
Portico TAV cuts prosthesis-patient mismatch ~50% and lowers 5-year structural valve deterioration vs SAPIEN 3.
Why the study?
Aortic valve replacement in small aortic annuli is associated with an increased risk of impaired haemodynamics, leading investigators to evaluate haemodynamic outcomes and PPM across different TAV types.
Does the Portico transcatheter aortic valve improve haemodynamic outcomes and reduce prosthesis-patient mismatch compared to Evolut and SAPIEN 3 in patients with aortic stenosis?
RCT
Yes
Does the Portico transcatheter aortic valve improve haemodynamic outcomes and reduce prosthesis-patient mismatch compared to Evolut and SAPIEN 3 in patients with aortic stenosis?
The intra-annular Portico valve demonstrated similar haemodynamic performance to Evolut and outperformed the balloon-expandable SAPIEN 3 for prosthesis-patient mismatch and mean gradient, with lower 5-year structural valve deterioration in small annuli.
Answers are grounded in this paper and cite their sources.
May favor Portico over SAPIEN 3 in small annuli; extends comparative durability data to 5 years.
BACKGROUND: Aortic valve replacement in small aortic annuli is associated with an increased risk of impaired haemodynamics. AIMS: We sought to evaluate haemodynamic outcomes and prosthesis-patient mismatch (PPM) in aortic stenosis (AS) patients treated with Portico, Evolut, and SAPIEN 3 transcatheter aortic valves (TAVs) in small (diameter ≤23 mm) and large (diameter >23 mm) aortic annuli. METHODS: PORTICO IDE was a prospective, multicentre, international, premarket randomised controlled trial comparing Portico to Evolut and SAPIEN 3 TAVs. An independent core laboratory evaluated the mean transvalvular pressure gradient (MG) and the effective orifice area (EOA), and PPM was calculated based on the core lab results. RESULTS: ; p<0.0001; PPM 5.4% vs 10.9%; p=0.0014). At 5 years, the rate of structural valve deterioration in patients with small aortic annuli was significantly lower in patients treated with Portico (2.2%) versus SAPIEN 3 (13.9%; p=0.03). CONCLUSIONS: Haemodynamic performance was similar for the intra-annular Portico and supra-annular Evolut. Portico haemodynamics outperformed the balloon-expandable SAPIEN 3 for PPM and mean gradient in both small and large aortic annuli.
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Fontana et al. (2026) conducted an RCT in aortic stenosis (AS). Portico transcatheter aortic valve vs. Evolut and SAPIEN 3 transcatheter aortic valves was evaluated on prosthesis-patient mismatch (PPM) (p=0.0014). Portico transcatheter aortic valves outperformed SAPIEN 3 for prosthesis-patient mismatch (5.4% vs 10.9%; p=0.0014) and 5-year structural valve deterioration (2.2% vs 13.9%; p=0.03).
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