Interventional Cardiology Journal Open Access

Propensity-score adjusted comparison of Evolut vs. Portico devices for transcatheter aortic valve implantation

2^nd Edition of EuroSciCon Congress on Heart Disease and Interventional Cardiology

February 25-26, 2019 | Paris, France

Giuseppe Biondi-Zoccai, Arturo Giordano, Nicola Corcione, Paolo Ferraro, Alberto Morello and Giacomo Frati

Pineta Grande Hospital, Italy Health House Saint Lucia, Italy Sapienza University of Rome, Italy IRCCS NeuroMed, Italy

Posters & Accepted Abstracts: Interv Cardiol J

Abstract:

Aim: Transcatheter aortic valve implantation (TAVI) has become an established treatment for severe aortic stenosis, thanks to key improvements achieved by new-generation devices. Their comparative effectiveness and safety is however still uncertain.

Methods: We queried a prospective registry on TAVI to compare Evolut and Portico, focusing on procedural, in-hospital and midterm outcomes. Unadjusted and propensity-adjusted analyses were carried out.

Results: A total of 233 patients were included, 119 (51.1%) receiving Evolut and 114 (48.9%) Portico. Several differences in baseline and procedural features were evident, including comorbidities, device size and post-dilation (all p<0.05). Unadjusted analysis for procedural results showed significant differences in fluoroscopy time, left ventricular ejection fraction and aortic regurgitation (all p<0.05), whereas device and procedural success rates were not significantly different (both p>0.05). In-hospital outcomes were not significantly different (all p>0.05). Survival analysis for mid-term follow-up (6±7 months) outcomes showed no significant differences in death, stroke, myocardial infarction, major vascular complication or major bleeding (all p>0.05). Conversely, Evolut appeared to be associated with lower peak and mean aortic gradients (both p<0.05), but higher rate of permanent pacemaker implantation (p=0.043). Propensity-score adjusted analysis largely confirmed the similar performance of the two devices, including peak and mean aortic gradients (both p>0.05). However, Evolut continued to be associated even at adjusted analysis with an increased risk of pacemaker implantation (p=0.018).

Conclusion: The acute and mid-term comparative safety and effectiveness of Evolut and Portico in experienced hands are similar, with the notable exception of a lower risk of permanent pacemaker implantation with Portico.

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