INTRODUCTION
Aortic stenosis(AS) is considered the most common valvular heart disease
with a prevalence of 2.8% in patients aged 75 years and over [1].
Its natural history has been well known for several years with a slow
and benign evolution when asymptomatic but a high mortality rate when
symptoms begin manifesting [2]. Since 1960, surgical aortic valve
replacement (AVR) has remained the gold standard treatment for AS,
promoting both survival and quality of life.
Since 2008, Transcathether Aortic Valve Replacement (TAVR) has proved a
reliable alternative to conventional surgery in non-operable patients,
in high-risk patients, more recently so in patients at intermediate and
low-risk groups [3–6].
The expandable Sapien 3 transcatheter heart valve (S3-THV; Edwards
Lifesciences, Irvine,CA,USA) has replaced the previous generation of
XT-THV, which was associated with a high prevalence of paravalvular
regurgitation (PVR). S3-THV provides a novel outer annular sealing skirt
that functions as a blood-soaked sponge and limits the risk of PVR
[7–9]. However, the protrusion of this skirt within the aortic
annulus combined with the proximity to the normal conduction pathways
have been shown to increase the risks of patient-prosthesis mismatch
(PPM) [10] and the implantation of pacemakers (PM) [9,11,12].
In the meantime, Rapid Deployment Aortic Valve Replacement (RDAVR) with
EDWARDS INTUITY Valve System (Edwards Lifesciences LLC, Irvine,
California) has been introduced as a hybrid option between conventional
and THV offering the benefits of both procedures. When compared to
conventional surgery, this allows reduction in cardiopulmonary bypass
time (CPBT) [13]. Moreover, the presence of a sub-annular
balloon-expandable stent frame, which functionally widens the left
ventricular outflow tract (LVOT), may ensure improved hemodynamic
performance and a larger effective orifice area (EOA) [14,15].
Even though previous prospective studies have already demonstrated the
non-inferiority of TAVR in intermediate-risk patients with symptomatic
severe AS when compared to conventional AVR, there has been no specific
validated study that exclusively compares RDAVR to TAVR.
The aim of the present study was therefore to retrospectively compare
the mid-term outcomes of intermediate risk patients with severe
symptomatic AS implanted with RDAVR or TAVR.