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TAVR With Three Generations of Self-Expanding Valves: STS/ACC TVT Registry Report
Study Questions:
What is the evolution of early outcomes for three iterative self-expanding transcatheter aortic valves?
Methods:
The investigators used data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (STS/ACC TVT) Registry for patients undergoing transcatheter aortic valve replacement (TAVR) with CoreValve, Evolut R, or Evolut PRO valves to treat tricuspid aortic stenosis between January 2014 and September 2017 for this analysis. Patient risk and echocardiographic data are site reported. Valves analyzed included 23-, 26-, and 29-mm sizes to fit 18- to 26-mm annular diameters. Propensity score matching was performed using the Evolut PRO group as the common reference.
Results:
Of 18,874 patients undergoing TAVR at 381 centers, 5,514 patients were implanted with CoreValve, 11,295 with Evolut R, and 2,065 with Evolut PRO valves. At 30 days, there were significantly fewer patients with more than mild aortic regurgitation for the unmatched (7.8% CoreValve, 5.2% Evolut R, and 2.8% Evolut PRO; p < 0.001) and matched populations (8.3% CoreValve, 5.4% Evolut R, and 3.4% Evolut PRO; p = 0.032). The mean aortic valve gradients at 30 days in the matched populations were <8 mm Hg for all three valves (7.3 mm Hg CoreValve, 7.5 mm Hg Evolut R, 7.2 mm Hg Evolut PRO).
Conclusions:
The authors concluded that advancements in transcatheter valve technologies and expanding indications for TAVR have resulted in improved outcomes for patients undergoing TAVR in the United States with self-expanding, supra-annular valves.
Perspective:
These registry data show that advancements in valve technologies for TAVR have resulted in improved outcomes after TAVR with self-expanding, supra-annular valves. Of note, the incorporation of an outer pericardial tissue wrap to enhance sealing at the level of the aortic annulus has resulted in very low rates of significant aortic regurgitation while maintaining excellent hemodynamic status. In particular, the Evolut PRO valve with the outer pericardial tissue wrap demonstrated exceptionally low rates of significant paravalvular leak while maintaining excellent hemodynamic status and low complication rates compared with prior generations of self-expanding transcatheter valves. TAVR is rapidly becoming a tenable option across the risk spectrum of patients with aortic stenosis, and continued technological advances as well as tailoring of both the approach and prosthesis type for each patient and their unique anatomy are indicated to improve patient outcomes.
Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and VHD, Interventions and Imaging, Interventions and Structural Heart Disease, Echocardiography/Ultrasound
Keywords: Aortic Valve Insufficiency, Aortic Valve Stenosis, Cardiac Surgical Procedures, Echocardiography, Hemodynamics, Heart Valve Diseases, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation, STS/ACC TVT Registry, Transcatheter Aortic Valve Replacement, Tricuspid Valve Stenosis
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