Long-term outcomes following transcatheter aortic valve implantation with the Portico self-expanding valve

Abstract

Aim Transcatheter aortic valve implantation (TAVI) is a mainstay in the management of severe aortic valve stenosis in elderly patients, but there is uncertainty on their long-term effectiveness. We aimed to assess the long-term outcome of patients undergoing TAVI with the Portico valve. Methods We retrospectively collected the data on patients in whom TAVI with Portico was attempted from 7 high-volume centres. Only patients theoretically eligible for 3 or more years of follow-up were included. Clinical outcomes, including death, stroke, myocardial infarction, reintervention for valve degeneration and hemodynamic valve performance were systematically assessed. Results A total of 803 patients were included, with 504 (62.8%) women, mean age of 82 years, median EuroSCORE II of 3.1%, and 386 (48.1%) subjects at low/moderate risk. The median follow-up was 3.0 years (3.0; 4.0). The composite of death, stroke, myocardial infarction, and reintervention for valve degeneration occurred in 37.5% (95% confidence interval: 34.1–40.9%), with all-cause death in 35.1% (31.8–38.4%), stroke in 3.4% (1.3–3.4%), myocardial infarction in 1.0% (0.3–1.5%), and reintervention for valve degeneration in 1.1% (0.6–2.1%). The mean aortic valve gradient at follow-up was 8.1 ± 4.6 mmHg, and at least moderate aortic regurgitation was present in 9.1% (6.7–12.3%). Independent predictors of major adverse events or death were: peripheral artery disease, chronic obstructive pulmonary disease, estimated glomerular filtration rate, atrial fibrillation, prior pacemaker implantation, EuroSCORE II, and reduced left ventricular ejection fraction (all p < 0.05). Conclusions Portico use is associated with favorable long-term clinical outcomes. Clinical outcomes were largely impacted by baseline risk factors and surgical risk.

Transcatheter Aortic Valve Implantation with the Portico Valve: 2-Year Outcomes of a Multicenter, Real-World Registry

“…It also improved the right ventricular and pulmonary artery hemodynamics ( Table 4 ). A more than mild paravalvular leak remained at 8.9% of the patients, higher than the reported incidence in the literature ( Table 5 ) [ 3 , 4 , 5 , 6 , 7 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ].…”

“…In this cohort, new PPM post-TAVI was required in 16.7% of the patients mainly due to third degree atrioventricular block, a rate closer to that of other registries (8.8–19.0%) and lower than that of the randomized Portico study (27.7%) ( Table 5 ) [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ].…”

“…Twenty-four-month mortality for Portico is available only from the one randomized study and goes up to 22.5%, three times higher than this cohort. Three-year all-cause mortality has a rate of 35.1% and is available only by one multicenter registry ( Table 5 ) [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ].…”

“…The efficacy and safety of the Portico system has been evaluated in several registries by presenting 30-day and 1-year outcomes and in one randomized study [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. However, long-term data >1 year are scarce [ 13 , 15 ]. The aim of this study was to evaluate outcomes at 2 years after TAVI with the Portico system.…”

Journal of Cardiovascular Pharmacology Welcomes New Associates

“…His research interests include advanced biostatistical methods, evidencebased medicine in cardiology, modified risk products of tobacco, primary and secondary cardiovascular prevention, and translational cardiovascular therapeutics. [6][7][8][9] On a personal note, Giuseppe informs me that his main professional (pre) occupation is being the father of 3 awesome boys, Giuseppe, Giovanni, and Attilio (named after the late Attilio Maseri) and the husband of a similarly awesome woman, Barbara. His "hobby of choice" is that of being an academic cardiologist.…”