Transcathether aortic valve implantation with the new repositionable self-expandable Evolut R versus CoreValve system: A case-matched comparison

Carlo Trani, Cristina Giannini, Marco De Carlo, Corrado Tamburino, Federica Ettori, Azeem M. Latib, Francesco Bedogni, Giuseppe Bruschi, Patrizia Presbitero, Arnaldo Poli, Franco Fabbiocchi, Roberto Violini, Pietro Giudice, Marco Barbanti, Marianna Adamo, Paola Colombo, Susanna Benincasa, Mauro Agnifili, A. Sonia Petronio

Risultato della ricerca: Contributo in rivistaArticolo in rivista

25 Citazioni (Scopus)

Abstract

Background Despite promising results following transcatheter aortic valve implantation (TAVI), several relevant challenges still remain. To overcome these issues, new generation devices have been developed. The purpose of the present study was to determine whether TAVI with the new self-expanding repositionable Evolut R offers potential benefits compared to the preceding CoreValve, using propensity matching. Methods Between June 2007 and November 2015, 2148 consecutive patients undergoing TAVI either CoreValve (n = 1846) or Evolut R (n = 302) were prospectively included in the Italian TAVI ClinicalService® project. For the purpose of our analysis 211 patients treated with the Evolut R were matched to 211 patients treated with the CoreValve. An independent core laboratory reviewed all angiographic procedural data and an independent clinical events committee adjudicated all events. Results Patients treated with Evolut R experienced higher 1-year overall survival (log rank test p = 0.045) and a significantly lower incidence of major vascular access complications, bleeding events and acute kidney injury compared to patients treated with the CoreValve. Recapture manoeuvres to optimize valve deployment were performed 44 times, allowing a less implantation depth for the Evolut R. As a consequence, the rate of more than mild paravalvular leak and new permanent pacemaker was lower in patients receiving the Evolut R. Conclusion In this matched comparison of high surgical risk patients undergoing TAVI, the use of Evolut R was associated with a significant survival benefit at 1 year compared with the CoreValve. This was driven by lower incidence of periprocedural complications and higher rates of correct anatomic positioning.
Lingua originaleEnglish
pagine (da-a)126-131
Numero di pagine6
RivistaINTERNATIONAL JOURNAL OF CARDIOLOGY
Volume243
DOI
Stato di pubblicazionePubblicato - 2017

Keywords

  • Aged
  • Aged, 80 and over
  • Aortic Valve Stenosis
  • Female
  • Follow-Up Studies
  • Heart Valve Prosthesis
  • Humans
  • Male
  • Postoperative Complications
  • Prospective Studies
  • Prosthesis Design
  • Retrospective Studies
  • Self-expandable transcatheter aortic valve
  • Survival Rate
  • Transcatheter Aortic Valve Replacement
  • Transcatheter aortic valve implantation

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