Comparison of the safety and efficacy of latest generation transcatheter heart valve systems: An all comers study.

Background: Latest generation transcatheter heart valves (THV) were introduced in the past years. Data to compare the safety and efficacy of these new generation THVs is limited.

Aim: To compare the outcomes of transfemoral ACURATE neo (NEO), Sapien 3 (S3) and Evolute R or PRO (PRO) patients in terms of device success and clinical safety outcomes.

Methods: Retrospective analysis of all patients undergoing transfemoral TAVI between the years 2016-2020. Patients were divided according to THV type NEO vs. S3 vs. PRO.

Results: A total of 898 patients were included in the present analysis, mean study population age was 81±8 years and 51.3% were women. NEO group included 80 (8.9%), S3 332 (36.9%) and PRO 465 (51.7%) patients. Baseline characteristics were comparable between groups except for higher rates of CAD and PVD among S3 patients. EuroSCORE2 was higher in the S3 group 5.7% vs. 4.4% in PRO and 2.8% in NEO group (p=0.045). Device success rates were lower for NEO (92.4%) compared to S3 (98.35) and PRO (96.7%) (p=0.009). There were no differences in procedural and in-hospital complication rates apart from conduction abnormalities. The rates of new-LBBB (16.7% vs 28.1% vs 23.2% p=0.09) and CAVB (11.3% vs 9.9% vs. 16.1%; p=0.001) were lower in NEO and S3 groups compared to PRO. However, these lower rates did not translate into lower pacemaker implantation rates. One year mortality did not differ between groups.

Conclusions: New generation THV are safe and effective. Minor advantages of one platform over the other may be utilized in tailoring the right platform for each patient.