title: Surgical sutureless and transcatheter aortic valves: hemodynamic performance and clinical outcomes in propensity score-matched high-risk populations with severe aortic stenosis.
abstract: OBJECTIVE
  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 cm(2)/m(2); p < 0.001), lower pressure gradient (8.14 ± 4.21 mm Hg vs. 10.72 ± 4.01 mm Hg; p = 0.006), less frequent prosthesis-patient 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.
authors.affiliation: Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands; 1st Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Kamperidis
authors.affiliation: Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Philippe J
authors.initials: PJ
authors.lastname: van Rosendael
authors.affiliation: Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Arend
authors.initials: A
authors.lastname: de Weger
authors.affiliation: Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Spyridon
authors.initials: S
authors.lastname: Katsanos
authors.affiliation: Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Madelien
authors.initials: M
authors.lastname: Regeer
authors.affiliation: Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: van der Kley
authors.affiliation: Medical Statistics Department, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Bart
authors.initials: B
authors.lastname: Mertens
authors.affiliation: 1st Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Sianos
authors.affiliation: Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Nina
authors.initials: N
authors.lastname: Ajmone Marsan
authors.affiliation: Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.affiliation: Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: v.delgado@lumc.nl.
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology*; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D057216:Propensity Score; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: aortic stenosis; prosthesis hemodynamics; survival; sutureless prosthesis; transcatheter prosthesis