Rapid Deployment vs Conventional Valves for Aortic Valve Replacement. Short- and Mid-term Outcomes. A Propensity Score Matching Comparison.

Abstract

Objectives: Rapid deployment Aortic valves have become an alternative for aortic valve stenosis treatment in recent years. Edwards Intuity was developed over Perimount Edwards Magna Ease design, with the addition of an infraannular ballon-expandable frame. So, we could hypothesize that outcomes should be similar between both protheses. Very few studies have compared these kinds of protheses. We communicate our experience with these prostheses. Methods: Retrospective observational study of 392 patients who receive aortic valve replacement in a single institution (175 Magna Ease, 117 Intuity). After adjustment through Propensity Score Matching (PSM), we obtained 65 couples of patients with equality in baseline characteristics. Results: Baseline values showed some differences between Intuity and Magna groups on terms of age (74.93 vs 73.21; p < 0.001), endocarditis (0 vs 8.1%; p < 0.001), diabetes (51 vs 30.3%; p < 0.001), Euroscore I (5.92 vs 6.82; p < 0.001), dyslipedemia (63.2% vs 47.3%; p < 0.005), previous cardiac surgery (0 vs 8.1%; p < 0.001) and combined cardiac procedure (12.8% vs 35.5%; p < 0.001). All baseline values were balanced after the employment of PSM. CBP (61.05± 17.18 vs 79.43± 21.78) and cross-clamp (42.38±11.44 vs 66.95± 17.05) times were lower in Intuity group (p < 0.001). There weren’t differences in terms of morbi-mortality. Incidence of new onset left bundle branch block was higher in Intuity group (26.2% vs 7.7%; p < 0.001). Intuity prostheses showed an higher incidence of postoperative paravalvular leak (12.3% vs 6.2%; p = 0.022) and lower 2-year transvalvular mean gradients (8.47 ± 2.81 vs 16.50 ± 5.21; p < 0.001). Conclusions: Our findings suggest that Intuity implants are related with better hemodynamics and surgical times than Magna prostheses. These outcomes enhance our knowledge on aortic prothesis profiles. Further randomized investigations are needed to estimate real differences between prostheses.