Surgical Sutureless and Transcatheter Aortic Valves Hemodynamic Performance and Clinical Outcomes in Propensity Score-Matched High-Risk Populations With Severe Aortic Stenosis

OBJECTIVES In propensity score-matched patients with severe aortic stenosis treated with surgical aortic valve replacement (AVR) with the 3f Enable sutureless prosthesis (Medtronic, Minneapolis, Minnesota) or transcatheter aortic valve replacement (TAVR), the hemodynamic performance of both valves and mid-term survival of patients were evaluated. BACKGROUND Data on hemodynamic performance of surgical sutureless bioprostheses in high operative risk patients with aortic stenosis are scarce. METHODS Of 258 patients undergoing TAVR or surgical aortic valve replacement with the 3f Enable valve, 80 (79 +/- 5 years of age, 100% men) were included in the current analysis on the basis of propensity score 1:1 matching for baseline clinical and hemodynamic characteristics. All patients had hemodynamic echocardiographic evaluation at baseline and discharge. Mid-term survival was analyzed. RESULTS Compared with the 3f Enable valve, TAVR prostheses (Edwards SAPIEN XT [Edwards Lifesciences, Irvine, California] and CoreValve [Medtronic]) had larger effective orifice area index (1.00 +/- 0.30 cm(2)/m(2) vs. 0.76 +/- 0.22 cm2/m2; p < 0.001), lower pressure gradient (8.14 +/- 4.21 mm Hg vs. 10.72 +/- 4.01 mm Hg; p = 0.006), less frequent prosthesispatient mismatch (30.0% vs. 67.5%; p = 0.001), and low flow (46.2% vs. 72.5%; p = 0.02), but more frequent aortic regurgitation (87.5% vs. 20.0%; p < 0.001). The presence of prosthesis-patient mismatch was independently associated with a low-flow state at discharge (odds ratio: 4.70; p = 0.004) and independently associated with the use of the sutureless prosthesis (odds ratio: 3.90; p = 0.02). However, the survival of the 2 groups was comparable after 1.5-year (interquartile range: 0.79 to 2.01 years) follow-up (log-rank test, p = 0.95). CONCLUSIONS TAVR prostheses demonstrated better hemodynamics than the 3f Enable valve but a higher incidence of aortic regurgitation. However, these differences did not influence mid-term survival of patients. (C) 2015 by the American College of Cardiology Foundation.