Background: Horizontal aorta (HA), defined by an aortic angulation (AA) >= 48 degrees, is associated with worse outcomes particularly after self-expanding (SE) trans-catheter heart valve (THV) implantation. Although the SE ACURATE Neo THV demonstrated favorable procedural success rates in patients with HA, it remains associated with a non-negligible rate of moderate or greater paravalvular leak (PVL).Objectives: Aim of the study was to assess the performance of ACURATE Neo2 in the setting of HA.Methods: We performed a multicenter cohort analysis on patients with severe aortic valve stenosis and HA undergoing transcatheter aortic valve replacement (TAVR) with the Neo or Neo2 THV enrolled in the ITAL-neo registry. The primary endpoint was a composite of early safety and clinical efficacy at 30 days according to the Valve Academic Research Consortium-3 (VARC-3). Secondary endpoints included the occurrence of moderate or severe PVL and 90-day clinical outcomes.Results: Among 900 patients included in the ITAL-neo registry, 407 exhibited HA; of these, 300 received a Neo THV and 107 a Neo2 THV. HA, irrespective of the THV implanted, emerged as an independent risk factor for developing >= moderate PVL. Technical and device success at 30-day follow-up was comparable between groups. However, Neo2 was associated with a significantly lower rate of >= moderate PVL vs. Neo: (5% vs. 15%; p < 0.001), which was confirmed also at 90-day follow-up. Additionally, no correlation was found between >= moderate PVL and AA in the Neo2 group, while PVL degree increased proportionally to the AA in the Neo cohort.Conclusion: In patients with HA, the new generation Acurate Neo2 THV was associated with a comparable device success rate and a significantly lower rate of >= moderate PVL, when compared with its predecessor.

Transcatheter aortic valve replacement with the self-expanding ACURATE Neo2 in patients with horizontal aorta: Insights from the ITAL-neo registry

De Carlo, Marco;Petronio, Anna Sonia;
2023-01-01

Abstract

Background: Horizontal aorta (HA), defined by an aortic angulation (AA) >= 48 degrees, is associated with worse outcomes particularly after self-expanding (SE) trans-catheter heart valve (THV) implantation. Although the SE ACURATE Neo THV demonstrated favorable procedural success rates in patients with HA, it remains associated with a non-negligible rate of moderate or greater paravalvular leak (PVL).Objectives: Aim of the study was to assess the performance of ACURATE Neo2 in the setting of HA.Methods: We performed a multicenter cohort analysis on patients with severe aortic valve stenosis and HA undergoing transcatheter aortic valve replacement (TAVR) with the Neo or Neo2 THV enrolled in the ITAL-neo registry. The primary endpoint was a composite of early safety and clinical efficacy at 30 days according to the Valve Academic Research Consortium-3 (VARC-3). Secondary endpoints included the occurrence of moderate or severe PVL and 90-day clinical outcomes.Results: Among 900 patients included in the ITAL-neo registry, 407 exhibited HA; of these, 300 received a Neo THV and 107 a Neo2 THV. HA, irrespective of the THV implanted, emerged as an independent risk factor for developing >= moderate PVL. Technical and device success at 30-day follow-up was comparable between groups. However, Neo2 was associated with a significantly lower rate of >= moderate PVL vs. Neo: (5% vs. 15%; p < 0.001), which was confirmed also at 90-day follow-up. Additionally, no correlation was found between >= moderate PVL and AA in the Neo2 group, while PVL degree increased proportionally to the AA in the Neo cohort.Conclusion: In patients with HA, the new generation Acurate Neo2 THV was associated with a comparable device success rate and a significantly lower rate of >= moderate PVL, when compared with its predecessor.
2023
Barki, Monica; Ielasi, Alfonso; Buono, Andrea; Maffeo, Diego; Montonati, Carolina; Pellegrini, Dario; Pellicano, Mariano; Gorla, Riccardo; Costa, Giuliano; Cozzi, Ottavia; Ancona, Marco; Soriano, Francesco; De Carlo, Marco; Ferrara, Erica; Giannini, Francesco; Massussi, Mauro; Fovino, Luca Nai; Messina, Antonio; Sgroi, Carmelo; Gallo, Francesco; Nerla, Roberto; Saccocci, Matteo; D'Ascenzo, Fabrizio; Conrotto, Federico; Bettari, Luca; Fiorina, Claudia; Castriota, Fausto; Poli, Arnaldo; Petronio, Anna Sonia; Oreglia, Jacopo; Montorfano, Matteo; Regazzoli, Damiano; Reimers, Bernhard; Barbanti, Marco; Tamburino, Corrado; Bedogni, Francesco; Tarantini, Giuseppe; Tespili, Maurizio
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11568/1221847
 Attenzione

Attenzione! I dati visualizzati non sono stati sottoposti a validazione da parte dell'ateneo

Citazioni
  • ???jsp.display-item.citation.pmc??? 0
  • Scopus 1
  • ???jsp.display-item.citation.isi??? ND
social impact