Comparison of Clinical and Echocardiographic Outcomes After Transcatheter Aortic Valve Implantation With 31-mm CoreValve Versus 34-mm Evolut R Bioprostheses from the STS/ACC TVT Registry

Abstract

Transcatheter aortic valve implantation with a bioprosthetic valve of insufficient size is associated with a higher risk of aortic regurgitation (AR). The 31-mm CoreValve and the next generation 34-mm Evolut R bioprostheses were designed to address the need for larger diameter aortic annuli. This analysis examined the clinical and hemodynamic outcomes following commercial transcatheter aortic valve implantation with the 31-mm CoreValve and 34-mm Evolut R in the Society of Thoracic Surgeons/the American College of Cardiology Transcatheter Valve Therapy Registry. Patients receiving a 31-mm CoreValve or 34-mm Evolut R valve for symptomatic severe native aortic stenosis from January 2014 to September 2017 in the Transcatheter Valve Therapy Registry underwent propensity score matching using baseline demographics, clinical and frailty measures, and procedural variables. Procedural characteristics, in-hospital and 30-day clinical and echocardiographic outcomes were compared. Of 4545 patients implanted with a 31-mm CoreValve and 3036 patients with a 34-mm Evolut R valve, matching resulted in 1813 patient sets. Most patients were male (>92%), elderly (∼80 years) with the Society of Thoracic Surgeons score of 6.6%. Use of the 34-mm versus 31-mm valve resulted in shorter median procedural time (113.0 [85.0, 150.0] vs 93.0 [71.0, 126.0] min, p <0.001), higher device success (98.1% vs 93.9%, p <0.001), fewer pacemakers (16.7% vs 24.6%, p <0.001), less ≥moderate AR with the 34-mm (5.5% vs 13.7%), p <0.001) and shorter hospital stay (3.0 [2.0, 4.0] vs 4.0 [3.0, 6.0] days, p <0.001). In conclusion, this largest experience with the 34-mm Evolut R valve showed higher device success, reduced hospital stay, lower pacemaker rates and less ≥moderate AR compared with the 31-mm CoreValve bioprosthesis.