Technological Improvements in Valves Translate into Clinical Results

Three generations of self-expanding valves, three different prognoses for our patients. Design improvements and better materials in self-expanding, supra-annular aortic valves, and their better results, have allowed for the expansion of the indication for transcatheter aortic valve replacement (TAVR). Particularly, the addition of a pericardial skirt improves annular sealing and results in a significantly low aortic regurgitation rate, while keeping the excellent hemodynamic profile featured by previous generations.

The aim of this work was to assess the evolution of outcomes for three consecutive generations of self-expanding valves.

Researchers analyzed data from the Society of Thoracic Surgeons and the American College of Cardiology for patients who underwent TAVR with CoreValve, Evolut R, or Evolut PRO valves to treat tricuspid aortic stenosis.

Valve sizes analyzed included 23-, 26-, and 29-mm sizes to fit 18- to 26-mm annular diameters. Propensity score matching was used to compare the 3 valve generations.

A total of 18,874 patients underwent TAVR at 381 centers; 5514 of them were implanted with CoreValve, 11,295 with Evolut R, and 2065 with Evolut PRO valves.

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At 30 days, the number of patients with severe to mild aortic regurgitation dropped significantly with design improvement (8.3% with CoreValve, 5.4% with Evolut R, and 3.4% with Evolut PRO; p = 0.032). The mean gradient was <8 mmHg for all three generations (7.3 mmHg for CoreValve, 7.5 mmHg for Evolut R, 7.2 mmHg for Evolut PRO).

Conclusion

Technological advancements in transcatheter aortic valve replacement have resulted in expanded indications, improving results in patients who received self-expanding, supra-annular valves. Among multiple improvements, the addition of a pericardial skirt in the Evolut PRO model seems to have had the highest impact.

Original Title: Three Generations of Self-Expanding Transcatheter Aortic Valves A Report From the STS/ACC TVT Registry.

Reference: John K. Forrest et al. J Am Coll Cardiol Intv 2020;13:170–9.

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