AIMS:

In valve-in-valve (v-i-v) transcatheter aortic valve replacement (TAVR) there are several considerations to deal with. A v-i-v procedure has higher risk of coronary obstruction and of patient-prothesis-mismatch (PPM) leaving the patient with high residual gradients. Abbot Portico®/Navitot® is a intra-annular selfexpanding valve with large stent cells to facilitate coronary access. The aim of this study is to compare the post-procedural hemodynamics after implantation of Medtronic Evolut® (ME) and Portico®/Navitor® (Abbott) (AP) in v-i-v procedures.

METHODS AND RESULTS:

Data from all v-i-v procedures performed at Sahlgrenska University Hospital, Gothenburg, Sweden between 2016-may 2023 were collected. The mean aortic valve gradient at the postprocedural echocardiography was the primary outcome and compared using an unadjusted model, a model matched for brand and true innerdiameter of the surgical bioprothesis and a linear regression model adjusted for age, gender, bioprosthesis valve fracturing, preprocedural ejection fraction and inner diameter of the surgical prosthesis.  During the study period, in total 106 valve-in-valve procedures were performed of which 86 were with ME and 20 with AP. Mean Euroscore II was 13% (p=0.93). All procedures were deemed successfull. The mean postprocedural gradient was 12.7 mmHg vs 13.6 mmHg. There were no statistical differences between the gradients in the matched cohort (p=0.90) or the in the adjusted model (adjusted difference 2.12, p=0.39). 

CONCLUSION:

The Portico@/Navitor® can achieve similar hemodynamic results in v-i-v procedures compared to the Evolut®. A randomized study is needed to further confirm these results.NULLNULL