Aortic Regurgitation in Patients Undergoing Transcatheter Aortic Valve Replacement with the Self-Expanding CoreValve versus the Balloon-Expandable SAPIEN XT Valve

Abstract The incidence of aortic regurgitation (AR) post transcatheter aortic valve replacement (TAVR) among a self-expanding and a balloon-expandable system are controversial. This study aimed to examine the incidence and severity of post TAVR AR with the CoreValve (CV) vs. the Edwards XT Valve (XT). Baseline, procedural and post-procedural in-hospital outcomes were compared. The primary endpoint was the incidence of post TAVR AR of any severity, assessed with a transthoracic echocardiogram, among the CV vs. XT groups. A multivariate logistic regression analysis was completed to evaluate for correlates of the primary endpoint. The secondary endpoints included the change in severity of AR at 30-days and 1-year follow-up. A total of 223 consecutive patients (53% male, mean age 82 years) who had transfemoral TAVR with either a CV (n=119) or XT (n=104) were evaluated. The rates of post TAVR AR among the groups were similar, and there was no evidence of more-than moderate AR in either group. There were significant differences in the rates of intra-procedural balloon post-dilation with the CV (17.1%) vs. XT valve (5.8%) (p=0.009) and in the rates of intra-procedural implantation of a second valve-in-valve prosthesis with the CV (9.9%) vs. XT valve (2.2%) (p=0.036). There were no significant differences among in-hospital safety outcomes between the two groups. In conclusion, the incidence of post TAVR AR is similar between the CV and the XT valve when performed by experienced operators utilizing optimal intra-procedural strategies, as deemed appropriate, to mitigate the severity of AR.