Partner valves: role of a prospective device selection strategy using ACURATE and SAPIEN 3 as complementary devices in transcatheter aortic valve implantation.

BACKGROUND

Transcatheter aortic valve implantation (TAVI) outcomes using balloon-expandable valves (BEV) and self-expanding valves (SEV) differ owing to device-specific technical features and anatomical factors.

OBJECTIVES

This study aimed to evaluate prospective TAVI device selection based on anatomic features to optimise outcomes compared with published randomised data using two newer-generation devices.

METHODS

A total of 607 consecutive patients with severe aortic stenosis treated at a single centre from 2020 to 2023 underwent TAVI using a prospective device selection strategy. Heavy and/or asymmetric valve calcification and bicuspid anatomy were preferentially treated with SAPIEN 3/SAPIEN 3 ULTRA BEV, whereas small annulus dimensions and less calcified valves were preferentially treated with ACURATE neo/ACURATE neo2 SEV. In-hospital Valve Academic Research Consortium-3 endpoints and 1-year mortality were evaluated.

RESULTS

ACURATE was used in 182 (30%) patients and SAPIEN 3 in 425 (70%) patients. The proportion of women was higher in the ACURATE group (65% vs. 31%, p < 0.001), and patients were older (84 vs. 80 years, p < 0.001). Technical success (97% vs. 97%, p > 0.99) and new permanent pacemaker implantation during index hospitalisation (10% vs. 10%, p > 0.99) did not differ between the ACURATE and SAPIEN 3 groups. Intended performance was higher in the ACURATE group than in the SAPIEN 3 group (98% vs. 91%, p = 0.005), with aortic regurgitation ≥moderate (2% vs. <1%, p = 0.32), and mean transvalvular gradient ≥20 mmHg (<1% vs. 4%, p = 0.043). The estimated mortality at 1 year was 14% versus 12% (log-rank p = 0.60) in the ACURATE and SAPIEN 3 groups, respectively.

CONCLUSIONS

A prospective device selection strategy using two complementary TAVI valves resulted in comparable outcomes between the SEV and BEV devices. In-hospital intended performance was higher in the ACURATE group. Despite baseline group differences, there was no difference in 1-year mortality.