Comparative Outcomes of Balloon-Expandable S3 Versus Self-Expanding Evolut Bioprostheses for Transcatheter Aortic Valve Implantation

ABSTRACT To-date, comparisons between the balloon-expandable Edwards Sapien S3 (S3) versus the self-expanding Evolut R or PRO (Evolut) valves have been limited with respect to procedural outcomes. We aim to compare the safety, efficacy and procedural efficiency of the S3 versus the Medtronic Evolut bioprostheses in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis. Retrospective analysis was performed of all consecutive TAVI procedures performed via the transfemoral approach with either S3 or Evolut at our hospital between September 2015 and January 2019. A total of 581 patients were included. There were no significant differences between S3 (n=452) versus Evolut (n=129) concerning in-hospital or 30-day safety outcomes. S3 was associated with significantly shorter fluoroscopy times, lower fluoroscopy Air Kerma, and higher contrast use. S3 had lower post-procedure AV area (1.71 ±0.45 vs. 1.84 ±0.50 cm2, p=0.004), larger peak gradient at 30-days (10.7 ±3.8 vs 7.0 ±3.2mmHg, p 26mm). Severe prosthesis-patient mismatch (PPM) was higher in S3 (14.8% vs. 7.9%, p