Zeitschrift für interventionelle Kardiologie Offener Zugang


Outcomes after implantation of the ACURATE neo and Portico transcatheter heart valves for the treatment of severe aortic stenosis

Lukas S. Keller, Stefan Toggweiler, Claudia Sütsch, Slayman Obeid, Felix C. Tanner, Miriam Brinkert, Lucca Loretz, Florim Cuculi, Richard Kobza, Frank Ruschitzka, Fabian Nietlispach.

Introduction: Among others the ACURATE neo and the Portico self-expanding transcatheter heart valves are widely used to treat severe aortic stenosis. So far, a direct comparison of the hemodynamics of these two valves is lacking. We want to fill this gap by a retrospective analysis of hemodynamic performance and the occurrence of new conduction disturbances.

Methods and results: Prospectively collected data at the University Hospital Zurich and the Heart Center Lucerne between December 2012 and April 2018 were analyzed. A total of 318 consecutive patients undergoing implantation of an ACURATE neo or a Portico valve formed the study population. The ACURATE neo was implanted in 144 patients (44% male) and the Portico in 174 patients (47% male). Patients receiving the ACURATE neo were older (82 ± 6 vs. 80 ± 7, p=0.03), had a higher LVEF (58 ± 12% vs. 54 ± 14%, p= 0.01) and a higher mean transvalvular pressure gradient at baseline (49 ± 17 vs. 41 ± 17 mmHg, p<0.001). There was no difference in annular size between the two groups (a perimeter of 75.3 ± 8.6 vs. 75.4 ± 5.2 mm, p=0.94).

Incidence of > mild paravalvular leak was low in both groups (3.4% in Portico vs. 5.6 % in ACURATE neo, p=0.42) at 30 days. The mean transvalvular pressure gradient after implantation of ACURATE neo was comparable to Portico (7 ± 4 mmHg vs. 8 ± 4 mmHg, p=0.05). New pacemaker insertion was significantly less frequent in the ACURATE neo group (2.5% vs. 10.9%, p=0.01).

Conclusion: Hemodynamic outcomes between the intra-annular Portico and the supra-annular ACURATE neo valve were similar with low transvalvular pressure gradients observed after implantation of both valves. Pacemaker rates after ACURATE neo implantation was lower