Outcomes after implantation of the ACURATE neo and Portico transcatheter heart valves for the treatment of severe aortic stenosis

Introduction and aim: Among others the ACURATE neo and the Portico self-expanding transcatheter heart valves are widely used to treat severe aortic stenosis. So far, a direct comparison of the hemodynamics of these two valves is lacking. We want to fill this gap by a retrospective analysis of hemodynamic performance and the occurrence of new conduction disturbances. Methods and results: Prospectively collected data at the University Hospital Zurich and the Heart Center Lucerne between December 2012 and April 2018 were analyzed. A total of 318 consecutive patients undergoing implantation of an ACURATE neo or a Portico valve formed the study population. The ACURATE neo was implanted in 144 patients (44% male) and the Portico in 174 patients (47% male). Patients receiving the ACURATE Neo were older (82±6 vs. 80±7, p=0.028), had a higher LVEF (58±12% vs. 54±14%, p= 0.004) and a higher mean transvalvular pressure gradient at baseline (49±17 vs. 41±17 mmHg, p<0.001). There was no difference in annular size between the two groups (a perimeter of 75.3±8.6 vs. 75.4±5.2 mm, p=0.941).  Incidence of >mild paravalvular leak was low in both groups (3.4% in Portico vs. 5.6 % in ACURATE neo, p=0.417) at 30 days.  The mean transvalvular pressure gradient after implantation of ACURATE neo was comparable to Portico (7±4 mmHg vs. 8±4 mmHg, p=0.05). New pacemaker insertion was significantly less frequent in the ACURATE neo group (2.5% vs. 10.9%, p=0.006). Conclusion: Hemodynamic outcomes between the intra-annular Portico and the supra-annular ACURATE neo valve were similar with low transvalvular pressure gradients observed after implantation of both valves. Pacemaker rates after ACURATE neo implantation was lower.