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Higher short-term mortality of Evolut versus Sapien 3: A piece of the puzzle?

  • Won-Keun Kim
    Correspondence
    Corresponding author at: Kerckhoff Heart Center, Department of Cardiology/Cardiac Surgery, Benekestr. 2-8, 61231 Bad Nauheim, Germany.
    Affiliations
    Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany

    Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany

    German Center for Cardiovascular Research (DZHK), Partner Site RhineMain, Bad Nauheim, Germany
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  • Mohamed Abdel-Wahab
    Affiliations
    Leipzig Heart Center, Department of Cardiology, Leipzig, Germany

    German Center for Cardiovascular Research (DZHK), Partner Site Leipzig, Leipzig, Germany
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Published:November 11, 2022DOI:https://doi.org/10.1016/j.ijcard.2022.11.013
      Since the introduction of transcatheter aortic valve implantation (TAVI) more than 20 years ago, we have witnessed a paradigm shift in the treatment of patients with aortic valve disease [
      • Siontis G.C.M.
      • Overtchouk P.
      • Cahill T.J.
      • Modine T.
      • Prendergast B.
      • Praz F.
      • et al.
      Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of symptomatic severe aortic stenosis: an updated meta-analysis.
      ]. Growing experience and knowledge, sophisticated imaging, and evolution of device technologies along with procedural refinements have contributed to major achievements in this field in terms of efficacy and safety. In a recent analysis from the STS-ACC TVT Registry, the latter two factors – device and procedural improvements – accounted for almost half of the improvement in 1-year mortality, 70% of the improvement in 30-day mortality, and 67% of the improvement in 30-day complications. (Arnold SV. Mediators of improvement in TAVR outcomes over time: insights from the STS-ACC TVT Registry. Presented at: TCT 2022. September 18, 2022. Boston, MA.). While this analysis underlines the impact of device iterations in general, the diversity of currently available device types with different principles of deployment and anchoring mandate a careful differential selection tailored to the individual patient anatomy to further optimize procedural outcomes [
      • Renker M.
      • Kim W.K.
      Choice of transcatheter heart valve: should we select the device according to each patient’s characteristics or should it be “one valve fits all”?.
      ,
      • Werner N.
      • Renker M.
      • Dorr O.
      • Bauer T.
      • Nef H.
      • Choi Y.H.
      • et al.
      Anatomical suitability and off-label use of contemporary transcatheter heart valves.
      ]. Even though head-to-head comparisons of early [
      • Abdel-Wahab M.
      • Mehilli J.
      • Frerker C.
      • Neumann F.J.
      • Kurz T.
      • Tolg R.
      • et al.
      Comparison of balloon-expandable vs self-expandable valves in patients undergoing transcatheter aortic valve replacement: the CHOICE randomized clinical trial.
      ] and of contemporary devices are available, the data for newer device generations are controversial [
      • He C.
      • Xiao L.
      • Liu J.
      Safety and efficacy of self-expandable Evolut R vs. balloon-expandable Sapien 3 valves for transcatheter aortic valve implantation: a systematic review and meta-analysis.
      ,
      • Alperi A.
      • Faroux L.
      • Muntane-Carol G.
      • Rodes-Cabau J.
      Meta-analysis comparing early outcomes following transcatheter aortic valve implantation with the Evolut versus Sapien 3 valves.
      ].
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