Rapid Deployment Aortic Valve Replacement versus Transcatheter Aortic Valve Replacement: A Comparison of Two Self-expanding and Stented Aortic Bio-prostheses

Objective: This single-center study directly compared clinical and echocardiographic outcomes in patients undergoing aortic valve replacement (AVR) either with a self-expanding surgical rapid deployment valve (RDV) Sorin Perceval S (PER) or transcatheter aortic valve replacement (TAVR) Symetis Acurate Neo (SYM).

Methods: A total of 168 patients with aortic valve stenosis underwent AVR between 2012 and 2017 as single procedure RDAVR (PER n = 34; Age: 74 ± 8 years) versus TAVR (SYM = 134; age: 83 ± 5 years). We extracted and analyzed relevant perioperative data from our institutional database to compare the self-expanding, stented bioprostheses PER and SYM with respect to clinical and hemodynamic outcomes.

Results: Preoperative characteristic of PER and SYM patients showed comparable body-mass index and surface area and EuroSCORE > 6.5. Preoperative echocardiography including ejection fraction, effective orifice area (EOA) peak and mean pressure gradients (PPG/MPG) were comparable in both groups. Implanted prosthesis size (PER 23.7 ± 1.5 vs. SYM 24.6 ± 1.4 mm) was larger in SYM and peak and mean PG (25 ± 13 vs 18 ± 7 mm Hg; 13 ± 7 vs 9 ± 4 mm Hg) showed higher gradients in PER. The rate of postoperative mild (PVL) (2.9 vs 70%; p < 0.05) and higher-degree PVL (9.7 vs. 0%) was higher in SYM compared with the PER group. Indexed EOA (PER 0.83 ± 0.1; SYM 0.93 ± 0.2) was similar between both groups and no patient prosthesis mismatch (iEOA< 0.65 cm²/m²) was identified. The need for new pacemaker implantation (8.8 vs. 8.9%), stroke rates (2.9 vs. 1.5%) and 30-day mortality (2.9 vs. 0.8%) was comparable for PER and SYM patients, respectively.

Conclusion: RDAVR with PER showed higher postoperative PPG and MPG, but significant lower overall PVL rates. Early clinical outcomes were comparable between PER and SYM.