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September 11, 2026Journal of the American College of Cardiology387 citations

Comparison of the Hemodynamic Performance of Percutaneous and Surgical Bioprostheses for the Treatment of Severe Aortic Stenosis

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MCMarie‐Annick ClavelJWJohn G. WebbPPPhilippe Pîbarot

Key Result

Percutaneous aortic valve implantation yielded a lower mean transprosthetic gradient at discharge (10 vs 13 and 14 mm Hg; P<0.001) than surgical valves, but higher rates of aortic regurgitation.

Key Points

  • To evaluate and compare the hemodynamic performance of catheter-implanted bioprosthetic aortic valves against stented and stentless surgical bioprostheses in patients with severe aortic stenosis.
  • Matched cohort comparison of 50 patients undergoing percutaneous aortic valve implantation (PAVI) matched 1:1 for sex, aortic annulus diameter, left ventricular ejection fraction, body surface area, and body mass index with 50 stented (SAVR-ST) and 50 stentless (SAVR-SL) surgical aortic valve replacement patients (total N=150).
  • Doppler echocardiographic evaluations were prospectively conducted before intervention, at hospital discharge, and at 6- to 12-month follow-up.
  • Mean transprosthetic gradient at discharge was significantly lower in the PAVI group (10 ± 4 mm Hg) than in the SAVR-ST (13 ± 5 mm Hg) and SAVR-SL (14 ± 6 mm Hg) groups (p < 0.001), remaining lower than SAVR-ST at follow-up (p < 0.001).
  • Severe prosthesis-patient mismatch occurred in 6% of PAVI patients versus 28% in the SAVR-ST and 20% in the SAVR-SL cohorts (p = 0.007).
  • Aortic regurgitation occurred more frequently with PAVI (mild: 42%, moderate: 8%) than with SAVR-ST (mild: 10%, moderate: 0%) and SAVR-SL (mild: 12%, moderate: 0%) at discharge (p < 0.0001) and remained higher at follow-up (p < 0.0001).

Study Design

Type

Cohort (n=150)

PICO

P
Population
150 patients with severe aortic stenosis undergoing percutaneous or surgical aortic valve replacement, matched 1:1 for baseline characteristics, followed for 6 to 12 months.
E
Exposure / Comparator
Percutaneous aortic valve implantation (PAVI) vs Surgical aortic valve replacement (SAVR) with stented or stentless bioprostheses
O
Primary Outcome
Mean transprosthetic gradient at discharge, p=< 0.001

Main Result

Absolute Event Rate: 10% vs 13%

p-value: p=< 0.001

Abstract

OBJECTIVES: This study was undertaken to compare the hemodynamic performance of a percutaneous bioprosthesis to that of surgically implanted (stented and stentless) bioprostheses for the treatment of severe aortic stenosis. METHODS: Fifty patients who underwent percutaneous aortic valve implantation (PAVI) with the Cribier-Edwards or Edwards SAPIEN bioprosthetic valve (Edwards Lifesciences, Inc., Irvine, California) were matched 1:1 for sex, aortic annulus diameter, left ventricular ejection fraction, body surface area, and body mass index, with 2 groups of 50 patients who underwent surgical aortic valve replacement (SAVR) with a stented valve (Edwards Perimount Magna SAVR-ST group), or a stentless valve (Medtronic Freestyle, Medtronic, Minneapolis, Minnesota SAVR-SL group). Doppler echocardiographic data were prospectively obtained before the intervention, at discharge, and at 6- to 12-month follow-up. RESULTS: Mean transprosthetic gradient at discharge was lower (p < 0.001) in the PAVI group (10 +/- 4 mm Hg) compared with the SAVR-ST (13 +/- 5 mm Hg) and SAVR-SL (14 +/- 6 mm Hg) groups. Aortic regurgitation (AR) occurred more frequently in the PAVI group (mild: 42%, moderate: 8%) compared with the SAVR-ST (mild: 10%, moderate: 0%) and SAVR-SL (mild: 12%, moderate: 0%) groups (p < 0.0001). At follow-up, the mean gradient in the PAVI group remained lower (p < 0.001) than that of the SAVR-ST group, but was similar to that of the SAVR-SL group. The incidence of severe prosthesis-patient mismatch was significantly lower (p = 0.007) in the PAVI group (6%) compared with the SAVR-ST (28%) and SAVR-SL (20%) groups. However, the incidence of AR remained higher (p < 0.0001) in the PAVI group compared with the 2 other groups. CONCLUSIONS: PAVI provided superior hemodynamic performance compared with the surgical bioprostheses in terms of transprosthetic gradient and prevention of severe prosthesis-patient mismatch, but was associated with a higher incidence of AR.

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Cite This Study

Clavel et al. (2009) conducted a cohort in Severe aortic stenosis (n=150). Percutaneous aortic valve implantation (PAVI) vs. Surgical aortic valve replacement (SAVR) with stented or stentless bioprostheses was evaluated on Mean transprosthetic gradient at discharge (p=< 0.001). Percutaneous aortic valve implantation yielded a lower mean transprosthetic gradient at discharge (10 vs 13 and 14 mm Hg; P<0.001) than surgical valves, but higher rates of aortic regurgitation.

synapsesocial.com/papers/6aa41bd983096b243c9c9ca2https://doi.org/10.1016/j.jacc.2009.01.060
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