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Small Size Self Expandable - Versus Balloon Expandable Transcatheter Aortic Valve Prosthesis. Comparison Of Early Postoperative Hemodynamic Function And Outcomes.
Mirko Doss, Thomas Walther.
Kerckhoff Heart Center, Bad Nauheim, Germany.

OBJECTIVE: Several transcatheter systems are available for the treatment of severe aortic stenosis in high risk patients. The aim of this study was to compare the early hemodynamic performance of two small (23 mm) transcatheter aortic valves: Symetis ACURATE and Edwards SAPIEN 3.
METHODS: Among 168 patients which were retrospectively identified in our database (March 2000 - August 2015) a total of 140 patients with eligible data were analyzed. The access of implantation was in 71 cases transapical (TA), in 69 cases transfemoral (TF). The ACCURATE valve was implanted in 62% (n = 87), SAPIEN 3 in 38% (n=53). In both groups the mean age was identical (83 years). There was no significant difference between the effective annulus diameter (ACURATE 22,0 mm, SAPIEN 3 22,3mm), septum thickness ( 12,6 mm vs 13,27 mm respectively), or ejection fraction (both 59%). The first postprocedural echocardiographic assessment including the mean gradient and the aortic valve area were compared.
RESULTS: The mean gradient for ACURATE - treated patients was 13,33 mmHg, for SAPIEN 3 14,98 mm. There was no significant difference between this two groups (p =0,1). No differences were observed in the aortic valve area (ACURATE 1,31 cm² versus SAPIEN 3 1,32 cm², P=0,9). In the sub analysis between two transapical groups the mean gradient was 14,25 mmHg for ACURATE versus 14,74 for SAPAIEN 3 patients (p = 0,6). The need for post-dilatation was significantly higher in the ACURATE Group (26,4 % vs 5,6 %, p = 0,001).
CONCLUSIONS: In this retrospective analysis there was no significant difference in the early postprocedural hemodynamic performance between two 23 mm transcatheter systems.


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