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.