Propensity-Matched Analysis of Early and Long-Term Clinical Outcomes with Self-Expandable Prostheses in TAVR: Portico...

Background: Transcatheter aortic valve replacement (TAVR) has emerged as a well-established option for patients with severe aortic stenosis who present high or extreme surgical risk. Direct comparisons of outcomes between different valve prostheses are important to assist operators in making an informed device selection. We aimed to perform a comparative analysis of early clinical outcomes at 30 days and long-term outcomes up to 3 years after TAVR using self-expandable Portico or CoreValve Evolut R valve prostheses. Methods: Out of 396 patients treated with either Portico or CoreValve Evolut R valves from January 2018 to December 2021, 79 patients were assigned to each group after 1:1 propensity score matching based on baseline parameters. Peri- and postprocedural outcomes at 30 days and up to a 3-year follow-up period were retrospectively collected according to the Valve Academic Research Consortium (VARC-2) criteria. Results: The immediate survival rate was 100% in both groups. The 30-day mortality was 0.0% in the Portico group and 1.3% in the CoreValve Evolut group (p = 1). Minor postprocedural bleeding was more frequent in the Evolut group both at 30 days (8.9% vs. 0%, p = 0.02) and at 3 years (11.4% vs. 3.8%, p = 0.133). There were no statistically significant differences regarding the combined safety endpoint (p = 1), acute kidney injury (AKIN 2 or AKIN 3) (p = 1; p = 0.477), or new pacemaker implantation (p = 0.31), at either 30 days or 3 years. Postprocedural myocardial infarction and stroke showed comparable rates in both groups. Conclusions: In terms of early clinical outcomes, no statistically significant differences were observed between the two groups of self-expandable valve prostheses, except for a significantly higher rate of minor bleeding in the Evolut group at 30 days. Notably, this trend of increased minor bleeding in the Evolut group persisted over the 3-year follow-up period, although the difference did not reach statistical significance. Both groups demonstrated low rates of all-cause mortality and clinical complications at long-term follow-up. The choice of valve should be customized to the individual characteristics of each patient.