Clinical and Hemodynamic Evaluation of the Perceval and Intuity Rapid Deployment Valves in Patients with Small Aortic Annulus
Vincent Chauvette1, Ariane Dasilva2, Yasmin Osman2, Pierre-Emmanuel Noly1, Walid Ben Ali1, Yoan Lamarche1, Philippe Demers1, Michel Pellerin1, Raymond Cartier1, Louis P. Perrault1, Michel Carrier1, Denis Bouchard1
1Montreal Heart Institute, Montreal, QC, Canada, 2University of Montreal, Montreal, QC, Canada
BACKGROUND: Patients with small aortic annulus are at risk of prosthesis-patient mismatch (PPM). Rapid deployment valves may effectively alleviate PPM in this patient population. However, little is known about the clinical and hemodynamic outcomes associated with different types of valve (Perceval versus Intuity) in this setting.
METHODS: Between 2012 and 2019, 165 patients with a small aortic annulus (Perceval size S or Intuity ≤21mm) underwent an aortic valve replacement in our institution. Among them, 39 received an Intuity valve (Group I) and 126 were implanted with a Perceval valve (Group P). The outcomes of these groups were compared.
RESULTS: Patients in Group P were significantly older than those in Group I (77±6 years vs 69±7 years, p<0.01). Apart from an history of prior cardiac intervention (I: 5% vs P: 21%, p=0.03), the prevalence of other preoperative comorbidities was similar between the 2 groups. A total of 107 patients had an aortic valve area (AVA) ≤0.85 cm2 (I=62% vs P=66%, p=0.70). The number of patients requiring concomitant procedures did not differ between Group I and P (46% vs 49%, p=0.85). Cross-clamp (I: 59±26 min vs P: 60±27 min, p=0.86) and bypass times (I: 78±32 min vs P: 78±35 min, p=0.94) were also similar. Major complications such as stroke (0% vs 6%, p=0.20), need for dialysis (0% vs 10%, p=0.07) and new pacemaker implantation (10% vs 14%, p=0.60) did not differ between Group I and P, respectively. At discharge, mean gradients were lower in Group I (14±6 mmHg vs 18±6 mmHg, p<0.01) and AVA were larger (1.7±0.5 cm2 vs 1.4±0.3 cm2, p<0.01). The signal was similar at 1 year (Figure 1). Three patients had PPM at 1 year, all were in Group P (p=0.99). At 4 years, the cumulative incidence did not differ between Group I and P (2.6±2.6% vs 9.8±4.9%, p=0.56). At 4 years, survival did not differ between the 2 groups (I: 90±5% vs P: 81±4%, p=0.13).
CONCLUSIONS: Rapid deployment valves offer low rates of PPM at 1 year in patients with small annulus. Patients in Group P had lower AVA and higher mean aortic gradients during follow-up. Further research is required to confirm these results. 