Comparison of Echocardiographic Outcomes Following Transcatheter Aortic Valve Replacement With Edwards S3 23 MM Versus Medtronic Evolut 26 MM Valves

Background

Patients with small aortic valve annulus (SAVA) undergoing TAVR are prone to higher post TAVR trans-valve gradients. In many such patients, the choice of TAVR valve commonly involves choosing between the Edwards S3 23 mm (ES23) versus the Medtronic Evolut 26 mm (ME26). The supraannular design of the Evolut has been touted as providing superior hemodynamics in SAVA. We sought to compare performance of these two valves in SAVA, particularly in regard to occurrence of elevated trans-valve gradients.

Methods

We queried the Providence St Joseph Health STS/ACC TVT Registry database for patients undergoing TAVR for SAVA with either the ES23 or ME26 between 2015Q3 and 2018Q1 at 11 hospitals in six states. Post TAVR echo results at 1 month and at 1 year were examined. High gradient was defined as mean gradient of ≥20 mmHg.

Results

Using the above criteria, we identified 608 patients treated with ES23 and 155 treated with ME26 (68% R/32% PRO). Baseline clinical (87% female) and echocardiographic characteristics were similar.

Conclusion

Patients with SAVA undergoing TAVR treated with ES23 had >70% higher mean gradient compared to ME26. High gradients (≥20 mmHg) were noted in 10% of ES23 valves at 1 month that increased to 16% at 1 year (rare at either time with ME26). These findings may have important clinical implications in the occurrence of patient prosthesis mismatch and possibly valve durability.