Third Generation Balloon-Expandable Transcatheter Valves versus Rapid Deployment Surgical Valves

Objectives: Benchmark trials comparing transcatheter and surgical aortic valve replacement (TAVR/SAVR) used specific transcatheter heart valves for comparison, but these did not specify which SAVR valve was used. These included general terms such as “surgical bioprosthesis.” Therefore, we aimed to compare the midterm clinical and echocardiography outcomes of transfemoral (TF) and transapical (TA) TAVR using the third generation balloon expandable valve in intermediate-risk patients with outcomes in intermediate-risk surgical cohort using one of the most recent developments in surgical aortic valve replacement, the rapid deployment valve (RD-SAVR).

Methods: Between March 2012 and April 2018, a total of 381 patients with severe aortic stenosis underwent TA-/TF-TAVR utilizing the third generation balloon expandable valve and RD-SAVR through a minimally invasive surgical access at our institution. We conducted clinical and echocardiographic midterm follow-up. The mean follow-up was 19.2 months.

Result: All study groups were at intermediate surgical risk. The 30-day all-cause mortality/ all-stroke rate in the TA, TF and RD-SAVR were 4.1%/1.6%, 3.9%/2.6%, and 3.8%/2.2%, respectively. The RD-SAVR showed significantly longer survival and longer probability of freedom from cardiac reinterventions and death than the TA-/TF-TAVR (p < 0.0001). The RD-SAVR showed significantly longer probability of freedom from stroke and death than the TA-/TF-TAVR (p = 0.001). The RD-SAVR had significant lower paravalvular leakage (PVL) and new pacemaker (PPI) rates than TA-/ TF-TAVR (p < 0.0001). At the time of discharge, the one-year post-procedure mean gradients were 9 ± 5.1/ 10 ± 4.5 mm Hg, 11 ± 4.1/ 12 ± 3.8 mm Hg, and 10.1 ± 4.3/ 10.4 ± 2.6 mm Hg in the TA-TAVR, TF-TAVR, and RD-SAVR respectively.

Conclusion: We observed similar early outcomes but significantly better midterm clinical outcomes in RD-SAVR using minimal invasive surgical approach than in TA-/ TF-TAVR using the third generation balloon expandable valve. The RD-SAVR was also a superior method concerning the PVL and the PPI.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021