Abstract 4783: Comparison of the Hemodynamic Performance of Percutaneous and Surgical (stented and stenless) Bioprostheses for the Treatment of Severe Aortic Stenosis
Percutaneous aortic valve implantation (PAVI) is emerging as an alternative to surgical aortic valve replacement (SAVR) for patients with symptomatic severe aortic stenosis (AS) considered to be at high or prohibitive operative risk. However, there is no data comparing the hemodynamic performance of percutaneous and surgical bioprostheses. To compare the hemodynamic performance of a percutaneous bioprosthesis to that of surgically implanted bioprostheses for the treatment of severe AS. A group of 50 patients who underwent PAVI with the Edwards-SAPIEN bioprosthetic valve were matched for gender, body mass index, body surface area, LV outflow tract diameter and LV ejection fraction with 2 groups of 50 patients who underwent SAVR with a stented (Edwards Magna, MGN) or a stentless (Medtronic Freestyle, FST) valve. Hemodynamic data were prospectively obtained with Doppler echocardiography in all patients before the intervention, at discharge, and at 6- to 12-month follow-up. Mean transprosthetic gradient at discharge was lower (p<0.001) in the PAVI group (10±4 mmHg) compared to the MGN (13±5 mmHg) and FST (14±6 mmHg) groups. Aortic regurgitation (AR) occurred more frequently in the PAVI group (2+: 42%, 3+: 8%) compared to the MGN (2+: 10%, 3+: 0%) and FST (2+: 12%, 3+: 0%) groups, p<0.001. At follow-up, the mean gradient in the PAVI group remained lower than that of the MGN group (10±4 mmHg vs. 13±5 mmHg, p<0.001), but was similar to that of the FST group (9±4 mmHg, p=NS). The incidence of severe prosthesis-patient mismatch (indexed valve effective orifice area ≤ 0.65cm 2/m2) was lower (p=0.008) in the PAVI group (6%) than in the MGN (30%) and FST (20%) groups. The incidence of AR remained higher (p<0.001) in the PAVI group (2+: 46%, 3+: 6%) compared with the 2 other groups (MGN, 2+: 10%, 3+: 2%; FST, 2+: 16%, 3+: 0%). The regurgitation was considered of paravalvular origin in 94% of the cases in the PAVI group, 56% in the MGN group, and 58% in the FST group. PAVI provided superior hemodynamic performance compared to the surgical bioprostheses in terms of transprosthetic gradient and prevention of severe prosthesis-patient mismatch, but was associated with a higher incidence of AR.