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.
Why the study?
The study was undertaken to compare the hemodynamic performance of a percutaneous bioprosthesis to that of surgically implanted stented and stentless bioprostheses for treating severe aortic stenosis.
Cohort (n=150)
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Matched cohort study reveals better transprosthetic gradients but higher regurgitation with percutaneous versus surgical valves in severe aortic stenosis, highlighting key trade-offs.
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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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.
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