Comparison of contemporary transcatheter heart valve prostheses: data from the German Aortic Valve Registry (GARY)

<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Various second-generation transcatheter heart valve (THV) prostheses with high clinical efficacy and safety are available, but there is limited large-scale data available comparing their hemodynamic performance and clinical implications.</jats:p> </jats:sec><jats:sec> <jats:title>Objective</jats:title> <jats:p>To compare the hemodynamic performance and short-term clinical outcome of four second-generation THV prostheses.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>24,124 patients out of the German Aortic Valve Registry who underwent transfemoral transcatheter aortic valve implantation (TAVI) (Evolut™ R <jats:italic>n</jats:italic> = 7028, Acurate neo™ <jats:italic>n</jats:italic> = 2922, Portico <jats:italic>n</jats:italic> = 878 and Sapien 3 <jats:italic>n</jats:italic> = 13,296) were included in this analysis. Propensity-score weighted analysis was performed to control for differences in age, left ventricular function, STS score and sex. Primary endpoint was survival at one-year, secondary endpoints were 30 days survival, pre-discharge transvalvular gradients, paravalvular leakage and peri-procedural complications.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>Thirty-day and one-year survival were not significantly different between the four patient groups. Transvalvular gradients in Evolut™ R and Acurate neo™ were significantly lower as compared to Portico and Sapien 3 at hospital discharge. This difference exists across all annulus sizes. Paravalvular leakage ≥ II occurred significantly less often in the Sapien 3 group (1.2%, <jats:italic>p</jats:italic> < 0.0001). Rate of severe procedural complications was low and comparable in all groups. Permanent pacemaker implantation rate at one year was lowest in the ACUARATE neo group (13.0%) and highest in the Evolut™ R group (21.9%).</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Albeit comparable short-term clinical outcomes there are certain differences regarding hemodynamic performance and permanent pacemaker implantation rate between currently available THV prostheses which should be considered for individual prosthesis selection.</jats:p> </jats:sec><jats:sec> <jats:title>Graphical Abstract</jats:title> </jats:sec>