Cardiologists have a wide selection of TAVR valves to choose from, and a new study pitting the top three second generation devices against each other suggests there’s not much difference in the long run.
- Second generation TAVR valves improve on first gen valves by featuring better deliverability, reduced paravalvular leakage, and easier repositioning or retrieval.
- So far, we haven’t known the long-term clinical outcomes of second-generation devices for TAVR beyond five years after implantation.
In a search for the king of TAVR valves, researchers compared seven year outcomes of Edward’s Sapien 3, Medtronic’s Evolut R/PRO, and Boston Scientific’s Acurate Neo, finding that all three had similar composite mortality, stroke, and HF re-hospitalization rates.
- Of the study’s 383 TAVR patients, 131 received the Sapien 3, 134 received the Evolut R/PRO, and 118 got the Acurate Neo.
- By the seven year follow up, the composite mortality, stroke and HF re-hospitalization rates were similar for all three (60.2% for Sapien 3, 51.6% for Evolut R/PRO, and 62.1% for Acurate Neo).
When it came to valve-related clinical efficacy, again all three valves were similar in their VARC-3 definitions (2.2% for Sapien 3, 1.2% for Evolut R/PRO, and 4.2% for Acurate Neo).
- Even in the case of valve durability, researchers found that all three contenders had similarly low rates of valve degeneration.
Before you get disappointed with the three way tie, there are a couple of serious caveats to mention about this study.
- First, the patient population is small relative to the number of people receiving these valves every year, so the sample isn’t the most representative.
- Second, the study only included patients who did not have a CT before TAVR, which excludes a good chunk of patients as well.
The Takeaway
While this study is framed like a head-to-head comparison, we’ll certainly need more powerful clinical studies before we can crown a king of the TAVR hill. That said, there’s some comfort in knowing that, at least in the first seven years after implantation, the most common valves all perform similarly well.
