Implantation and 30-Day Follow-Up on All 4 Valve Sizes Within the Portico Transcatheter Aortic Bioprosthetic Family

• Published in: JACC. Cardiovascular interventions Vol. 10; no. 15; pp. 1538 - 1547
• Main Authors: Möllmann, Helge, Linke, Axel, Holzhey, David M., Walther, Thomas, Manoharan, Ganesh, Schäfer, Ulrich, Heinz-Kuck, Karl, Van Boven, Ad J., Redwood, Simon R., Kovac, Jan, Butter, Christian, Søndergaard, Lars, Lauten, Alexander, Schymik, Gerhard, Worthley, Stephen G.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 14.08.2017
• Subjects: Aged; Aged, 80 and over; all-cause mortality; Aortic Valve - diagnostic imaging; Aortic Valve - physiopathology; Aortic Valve - surgery; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Australia; Bioprosthesis; Europe; Female; Heart Valve Prosthesis; hemodynamic performance; Hemodynamics; Humans; Male; Postoperative Complications - etiology; Prospective Studies; Prosthesis Design; Recovery of Function; Risk Factors; Severity of Illness Index; TAVR; Time Factors; transcatheter aortic valve replacement; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - instrumentation; Transcatheter Aortic Valve Replacement - mortality; transfemoral; Treatment Outcome; NYHA; hemodynamic performance; AR; AS; VARC; transfemoral; all-cause mortality; PVL; transcatheter aortic valve replacement; PPI; TAVR
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2017.05.021

The aim of this study was to evaluate the short-term safety and performance of the full range of valve sizes offered within the Portico transcatheter aortic valve replacement system. The Portico transcatheter aortic heart valve is a fully resheathable, repositionable, and self-expanding bioprosthesis designed to achieve optimal valve position and hemodynamic performance and limit conduction disturbances. Patients (n = 222) with symptomatic (New York Heart Association functional class ≥II) severe aortic stenosis considered by a multidisciplinary heart team to be at high surgical risk were recruited between December 2011 and September 2015 in this prospective, nonrandomized, multicenter study. Patients were implanted with the full range of Portico heart valves (23, 25, 27, and 29 mm) using the transfemoral approach. The primary endpoint was all-cause mortality at 30 days. Secondary endpoints included valve performance, improvement in functional class, and procedural outcomes as defined by Valve Academic Research Consortium criteria. A total of 220 patients (mean age 83.0 ± 4.6 years, 74.3% women, mean Society of Thoracic Surgeons score 5.8%) had valves implanted. All resheathing and repositioning attempts (n = 72) were successful. At 30 days, all-cause mortality was 3.6%. Procedural outcomes included disabling (major) stroke (3.2%), major vascular complications (7.2%), and permanent pacemaker implantation (13.5%). Compared with baseline, 75.8% of patients improved by ≥1 New York Heart Association functional class at 30 days. The rate of moderate paravalvular leak was 5.7%, with no severe paravalvular leak reported. No differences in paravalvular leak incidence and severity were observed among valve sizes (p = 0.24). Across all valve sizes, use of the repositionable Portico transcatheter aortic valve replacement system resulted in safe and effective treatment of aortic stenosis in high-risk patients. [Display omitted]