Transcatheter aortic valve implantation with the Portico and Evolut R bioprostheses in patients with elliptic aortic annulus

AIMS: To compare paravalvular leak (PVL) and device success rate of two self-expanding devices (Portico and Evolut-R) in patients with elliptic aortic annulus undergoing transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS: This retrospective study included 374 patients submitted to TAVI with Portico (n=111) and Evolut-R (n=263), and available aortic annulus measurements at computed tomography angiography. Aortic annulus was defined elliptic if the index of eccentricity (IE=1-aortic annulus (minimum diameter)/(maximum diameter)) was >0.25. Device behavior to annulus eccentricity variations was measured by computational simulation in an idealized aortic root with three different IE (0, 0.25, and 0.5). An elliptic aortic annulus was found in 107 (28.6%) of 374 patients. Fewer rates of >moderate PVL were observed in Portico elliptic group compared to Evolut-R elliptic group (0.0% vs.15.2%; P=0.034). Device success in Portico elliptic group (100%) was significantly higher compared to that of Evolut-R elliptic group (84.8%; P=0.019). Eccentricity was a positive predictor of device success only in Portico patients (P=0.021). On computational simulation, Portico showed stable stent root interaction area, stress distribution, and regurgitant orifice area for IE=0.25 and 0.5. CONCLUSIONS: Portico showed good adaptability to annulus eccentricity variations and excellent PVL/device success rates in elliptic patients, compared to Evolut-R.