Outcomes and performance of the ACURATE neo2 transcatheter heart valve in clinical practice: one-yearresults of the ACURATE neo2 PMCF Study

One-year hemodynamic and clinical outcomes in self-expanding valves: Comparison of ACURATE neo2 versus ACURATE neo

BACKGROUND/PURPOSE

Transcatheter aortic valve replacement (TAVR) with ACURATE neo2 showed better hemodynamic outcomes by mitigating paravalvular leakage (PVL) compared with ACURATE neo, and revealed promising one-year outcomes in single-arm studies. However, studies comparing the hemodynamic and clinical outcomes of the two valves are still scarce. Therefore, this study aimed to compare the one-year hemodynamic and clinical outcomes between the neo2 and neo.

METHODS/MATERIALS

We analyzed 562 patients who underwent TAVR with ACURATE neo2 (n = 207) or ACURATE neo (n = 355). The primary outcome was one-year all-cause mortality. The secondary outcomes were hemodynamic outcomes at hospital discharge, 3-month, and one-year post-procedure.

RESULTS

In propensity score matching comparison (172 pairs), there was no significant difference in one-year all-cause mortality between the two groups (neo2: 7.0 % vs. neo: 6.4 %, Log-rank p = 0.8101). While the mean aortic valve pressure gradient was significantly higher in the neo2 group at discharge, the difference was not detected after one year (8.1 ± 3.8 mmHg vs. 8.2 ± 3.7 mmHg, p = 0.8862). The PVL grade did not differ between the two groups at any time point. However, the incidence of moderate or severe PVL significantly decreased at one-year post-procedure compared with that at discharge only in the neo2 group (discharge: 7.2 % vs. one year: 1.5 %, p = 0.0455).

CONCLUSIONS

The one-year all-cause mortality rate for ACURATE neo2 was similar to that of ACURATE neo. ACURATE neo2 showed the subsequent improvement of significant PVL, which might result in better long-term clinical outcomes than ACURATE neo.

SUMMARY FOR ANNOTATED TABLE OF CONTENTS

This study compared one-year all-cause mortality and hemodynamic outcomes after TAVR between ACURATE neo2 and ACURATE neo implantation. One-year all-cause mortality rate and significant improvement in the mean APG after TAVR for ACURATE neo2 were similar to those of ACURATE neo. ACURATE neo2 revealed the subsequent improvement of significant PVL for one year, which might result in better long-term clinical outcomes than ACURATE neo.

1-Year Outcomes of Transcatheter Aortic Valve Replacement Using a Self-Expanding vs Balloon-Expandable Transcatheter Aortic Valve

BACKGROUND

Mid-term comparative data for the self-expanding ACURATE neo2 transcatheter heart valve and the balloon-expandable SAPIEN 3 Ultra are lacking.

OBJECTIVES

The aim of this study was to compare 1-year outcomes after transcatheter aortic valve replacement of these 2 valves.

METHODS

A total of 2,106 patients from 3 centers (neo2, n = 1,166; Ultra, n = 940) undergoing transfemoral transcatheter aortic valve replacement were analyzed retrospectively. The primary endpoint was the composite of all-cause mortality, stroke, and rehospitalization at 1 year. Secondary endpoints were the individual components of the primary endpoint at 1 year. To adjust for baseline differences, nearest neighbor propensity score matching was used.

RESULTS

After matching (702 pairs), baseline characteristics were similar between groups. Device success was more common in the neo2 group (87.5% vs 82.3%; P = 0.007), irrespective of matching. DP mean after the procedure was higher for Ultra (13 mm Hg [Q1-Q3: 10-15 mm Hg] vs 8 mm Hg [Q1-Q3: 6-11] mm Hg; P < 0.001). Rates of paravalvular leakage, device embolization, and multiple valve implantations were more common in the neo2 arm, whereas major cardiac structural complications and major vascular complications occurred more frequently in the Ultra group. All other in-hospital complication rates were similar between the 2 groups. At 1 year, the cumulative incidence of the primary endpoint (14.1% for neo2 vs 14.5% for Ultra; P = 0.819) was similar between the groups. Likewise, the individual components showed no difference between the groups.

CONCLUSIONS

Despite differing immediate results, the outcomes at 1 year, including the composite of all-cause mortality, stroke, or hospitalization, were similar for neo2 and Ultra transcatheter heart valves.

Short-Term Outcomes of ACURATE neo2

Inferior outcomes with ACURATE neo, a self-expanding transcatheter heart valve (THV) for the treatment of severe aortic stenosis, were mainly driven by higher rates of moderate/severe paravalvular leak (PVL). To overcome this limitation, the next-generation ACURATE neo2 features a 60% larger external sealing skirt. Data on long-term performance are limited; however, clinical evidence suggests improved short-term performance which is comparable to contemporary THVs. This report reviews data on short-term clinical and echocardiographic outcomes of ACURATE neo2. A PubMed search yielded 13 studies, including 5 single arm and 8 nonrandomized comparative studies with other THVs which reported in-hospital or 30-day clinical and echocardiographic outcomes. In-hospital or 30-day all-cause mortality was ≤3.3%, which is comparable to other contemporary THVs. The rates of postprocedural ≧moderate PVL ranged 0.6%-4.7%. In multicenter propensity-matched analyses, neo2 significantly reduced the rate of ≧moderate PVL compared to neo (3.5% vs. 11.3%, p < 0.01), whereas rates were comparable to Evolut Pro/Pro+ (Neo2: 2.0% vs. Pro/Pro+: 3.1%, p = 0.28) and SAPIEN 3 Ultra (Neo2: 0.6% vs. Ultra: 1.1%, p = 0.72). The rate of permanent pacemaker implantation with neo2 was consistently low (3.3%-8.6%) except in one study, and in propensity-matched analyses were significantly lower than Evolut Pro/Pro+ (6.7% vs. 16.7%, p < 0.01), and comparable to SAPIEN 3 Ultra (8.1% vs. 10.3%, p = 0.29). In conclusion, ACURATE neo2 showed better short-term performance by considerably reducing PVL compared to its predecessor, with short-term clinical and echocardiographic outcomes comparable to contemporary THVs.