A Comparison Between First-Generation and Second-Generation Transcatheter Aortic Valve Implantation (TAVI) Devices: A Propensity-Matched Single-Center Experience

作者：Ruparelia Neil; Latib Azeem; Kawamoto Hiroyoshi; Buzzatti Nicola; Giannini Francesco; Figini Filippo; Mangieri Antonio; Regazzoli Damiano; Stella Stefano; Sticchi Alessandro; Tanaka Akihito; Ancona Marco; Agricola Eustachio; Monaco Fabrizio; Spagnolo Pietro; Chieffo Alaide; Montorfano Matteo; Alfieri Ottavio; Colombo Antonio^*

来源：Journal of Invasive Cardiology, 2016, 28(5): 210-216.

• transcatheter aortic valve implantation
• TAVI
• TAVR
• first generation
• second generation

Background. Transcatheter aortic valve implantation (TAVI) is the treatment of choice for high-risk patients presenting with severe symptomatic aortic stenosis. The aim of this study was to investigate the impact of second-generation (2G) devices in comparison to first-generation (1G) devices with regard to procedural and short-term clinical outcomes. Methods. Between November 2007 and May 2015, a total of 449 patients treated with 1G TAVI devices (Edwards Sapien XT, Medtronic CoreValve) were propensity matched (1: 1) to 179 patients treated with 2G TAVI devices (Edwards Sapien 3, Medtronic Evolut R, Boston Scientific Lotus, Direct Flow Medical). The primary endpoint was 30-day safety according to the Valve Academic Research Consortium 2 (VARC-2) definition. Results. Patients treated with 1G devices suffered more adverse events at 30-day follow-up (freedom of adverse events, 75.3% vs 88.8%; hazard ratio, 2.4; 95% confidence interval (CI), 1.4-4.0; P=. 01) and a significantly greater number of minor vascular complications (31.8% vs 10.4%; P<. 001) and major vascular complications (3.2% vs 0.6%; P<. 001) compared with patients treated with 2G devices. The presence of residual aortic regurgitation >= 2 was also greater in the 1G group (17.5% vs 5.8%; odds ratio, 0.30; 95% CI, 0.13-0.69; P<. 001). There were no differences between groups with regard to 30-day all-cause mortality (5.2% vs 3.2%; odds ratio, 0.61; 95% CI, 0.20-1.92; P=. 40). Conclusion. TAVI with contemporary 2G devices was associated with a significant safety benefit at 30 days and reduction of residual moderate or severe paravalvular leak. Longer-term follow-up in more patients is required to determine if these short-term benefits translate into improvements in long-term clinical outcomes.

• 出版日期2016-5