Transcatheter aortic-valve replacement with the self-expanding valve Portico in low-risk patients

Abstract

Abstract Background In the past years, transcatheter aortic-valve replacement (TAVR) has risen as a feasible and safe option for patients with aortic stenosis, been now an option of treatment in low-risk (Euroscore II <4%) patients over 75 years.1 Evidence of this treatment with self-expandable supraanular bioprothesis Evolut have widely proven to be no inferior to surgical valve replacement.2 Nevertheless, experience of the annular self-expandable prothesis Portico available in this population is scarce. Purpose We present our early experience with the annular self-expandable prothesis Portico in our low-risk population. Methods We retrospectively studied 219 symptomatic low-risk patients with who underwent TAVR procedure with self-expandable valves between 2018 and 2021. Assessment included echocardiogram, immediate and 30-day follow-up, as well as last clinical visit follow-up. 92 subjects received an annular Portico prothesis. Our reference group was the suprannular prothesis Evolut (n=127), already validated for low-risk patients in clinical trials.2 Results The mean age of the patients was 79 years, 43.4% were women, and all the patients were at low surgical risk (2.2 [1.6; 3.0]). No significant differences could be appreciated in baseline demographics and echocardiographic characteristics except for body mass index (BMI), which was higher in the Portico group (p<0.001) (Table). Procedure length was similar, with the particular need of higher predilation in the Portico group according to recommendations. Both self-expandable prothesis had similar rates of intraprocedural atrioventricular block, bleeding, vascular complications, stroke, and new onset atrial fibrillation. Mean aortic-valve gradients before discharge were lower at the suprannular Evolut group than in the annular Portico group, and immediate residual aortic regurgitation was almost inexistent in both groups (Table 1). At a 30-day follow up, the incidence of major adverse cardiac events was low and similar among groups (p=0.6) (Figure 1), with no significant differences in the incidence of permanent pacemaker implantation, heart failure admission, stroke, bleeding o vascular complication (Figure 1). Conclusion Annular aortic self-expandable prothesis Portico is a feasible alternative for patients with AS and low surgical risk who undergo TAVR procedure. Funding Acknowledgement Type of funding sources: None.