title: Comparison of two valve systems for transapical aortic valve implantation: a propensity score-matched analysis.
abstract: OBJECTIVE
  Several alternative transapical (TA) aortic prostheses for aortic valve implantation (AVI) have recently become available. Data directly comparing the performance of these different TA-AVI valves, however, are sparse. Therefore, we sought to analyse the performance of the better-established balloon-expandable SAPIEN XT™ valve system, and compare it with the recently approved self-expandable ACURATE TA™ system by means of propensity score (PS) analysis.
  
  
  METHODS
  Samples from a total of 310 consecutive patients treated with transapical transcatheter aortic valve implantation (TAVI) were included (2010-2014). The ACURATE valve was implanted in 40% (n = 131), SAPIEN in 60% (n = 179). To adjust for baseline differences, 1:1 PS matching was used, and resulted in 103 matched pairs. In addition to demographical and clinical variables, potential anatomical confounders (calcification grade: computed tomography (CT) Agatston score; annulus diameter: CT-effective diameter) were included within the PS estimation.
  
  
  RESULTS
  For ACURATE- versus SAPIEN-treated patients, the mean age was 83.1 ± 5.4 vs 79.8 ± 9.5 (P < 0.001). Mean Society of Thoracic Surgeon scores were 7.7 ± 4.6 vs 8.1 ± 6.0 (P = 0.56). PS matching resulted in bias reduction <0.2, indicating excellent balance and allowing for valid outcome comparison. Device success, 30-day mortality rate and 1-year survival were comparable. Pacemaker and 30-day neurological event rates were not significantly different. The need for post-ballooning was significantly higher in the self-expandable group (40% vs 9%; P < 0.001). Echocardiography upon discharge demonstrated excellent functional outcomes regarding residual paravalvular leaks (ACURATE: 3% vs SAPIEN: 4%, P = 1.0) with slightly higher mean gradients in the ACURATE group (12 ± 5 mmHg vs 10 ± 5 mmHg, P = 0.003).
  
  
  CONCLUSIONS
  The two transapical TAVI devices demonstrated comparable haemodynamic performance and clinical outcome. The self-expandable valve required more frequent post-ballooning without affecting the safety profile.
authors: Department of Cardiac Surgery, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany.
authors: Jörg
authors: J
authors: Kempfert
authors: Department of Cardiac Surgery, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany meyer.alexander@gmail.com.
authors: Alexander
authors: A
authors: Meyer
authors: Department of Cardiac Surgery, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany Department of Cardiology, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany.
authors: Won-Keun
authors: WK
authors: Kim
authors: Department of Cardiac Surgery, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany.
authors: Arnaud
authors: A
authors: Van Linden
authors: Department of Cardiac Surgery, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany.
authors: Mani
authors: M
authors: Arsalan
authors: Department of Cardiology, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany.
authors: Johannes
authors: J
authors: Blumenstein
authors: Department of Cardiology, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany.
authors: Helge
authors: H
authors: Möllmann
authors: Department of Cardiac Surgery, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany.
authors: Thomas
authors: T
authors: Walther
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D063126:Balloon Valvuloplasty / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D004812:Epidemiologic Methods; D005260:Female; D006350:Heart Valve Prosthesis; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D011474:Prosthesis Design; D065467:Transcatheter Aortic Valve Replacement / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome
keywords: Aortic valve implantation; Minimally invasive; Transapical