Background Rapid deployment aortic valve replacement (RDAVR) and transcatheter aortic valve implantation (TAVI) have emerged as increasingly used alternatives to conventional aortic valve replacement to treat patients at higher surgical risk. Therefore, in this single-center study, we retrospectively compared clinical outcomes and hemodynamic performance of two self-expanding biological prostheses, the sutureless and rapid deployment valve (RDV) Perceval-S (PER) and the transcatheter heart valve (THV) ACURATE neo/TF (NEO) in a 1:1 propensity-score-matching (PSM) patient cohort.

Methods A total of 332 consecutive patients with symptomatic aortic valve stenosis underwent either singular RDAVR with PER (119) or TAVI with NEO (213) at our institutions between 2012 and 2017. To compare the unequal patient groups, a 1:1 PSM for preoperative data and comorbidities was conducted. Afterward, 59 patient pairs were compared with regard to relevant hemodynamic parameter, relevant paravalvular leak (PVL), permanent postoperative pacemaker (PPM) implantation rate, and clinical postoperative outcomes.

Results Postoperative clinical short-term outcomes presented with slightly higher rates for 30-day all-cause mortality (PER = 5.1% vs. NEO = 1.7%, p = 0.619) and major adverse cardiocerebral event in PER due to cerebrovascular events (transient ischemic attack [TIA]-PER = 3.4% vs. TIA-NEO = 1.7%, p = 0.496 and Stroke-PER = 1.7% vs. Stroke-NEO = 0.0%, p = 1). Moreover, we show comparable PPM rates (PER = 10.2% vs. NEO = 8.5%, p = 0.752). However, higher numbers of PVL (mild—PER = 0.0% vs. NEO = 55.9%, p = 0.001; moderate or higher—PER = 0.0% vs. NEO = 6.8%, p = 0.119) after TAVI with NEO were observed.

Conclusion Both self-expanding bioprostheses, the RDV-PER and THV-NEO provide a feasible option in elderly and patients with elevated perioperative risk. However, the discussed PER collective showed more postoperative short-term complications with regard to 30-day all-cause mortality and cerebrovascular events, whereas the NEO showed higher rates of PVL.

背景 快速部署主动脉瓣置换术 (RDAVR) 和经导管主动脉瓣植入术 (TAVI) 已成为越来越多地用于替代传统主动脉瓣置换术来治疗手术风险较高的患者。因此，在这项单中心研究中，我们回顾性比较了两种自膨式生物假体、无缝线快速展开瓣 (RDV) Perceval-S (PER) 和经导管心脏瓣膜 (THV) ACURATE neo 的临床结果和血流动力学性能。/TF (NEO) 在 1:1 倾向评分匹配 (PSM) 患者队列中。

方法 2012 年至 2017 年期间，共有 332 名有症状的主动脉瓣狭窄患者在我们的机构接受了单次 RDAVR 与 PER（119）或 TAVI 与 NEO（213）。为了比较不平等的患者组，术前采用 1:1 PSM进行了数据和合并症。之后，对 59 对患者的相关血流动力学参数、相关瓣周漏 (PVL)、永久性术后起搏器 (PPM) 植入率和临床术后结果进行了比较。

结果 术后临床短期结果的 30 天全因死亡率（PER = 5.1% vs. NEO = 1.7%，p  = 0.619）和 PER 中因脑血管事件（短暂性缺血攻击 [TIA]-PER = 3.4% vs. TIA-NEO = 1.7%，p  = 0.496 和 Stroke-PER = 1.7% vs. Stroke-NEO = 0.0%，p  = 1）。此外，我们显示了可比的 PPM 率（PER = 10.2% 与 NEO = 8.5%，p  = 0.752）。然而， 在 TAVI 与 NEO 后观察到更高数量的 PVL（轻度 - PER = 0.0% 与 NEO = 55.9%，p  = 0.001；中度或更高 - PER = 0.0% 与 NEO = 6.8%，p = 0.119）。

结论 自膨式生物假体 RDV-PER 和 THV-NEO 为老年人和围手术期风险升高的患者提供了一种可行的选择。然而，所讨论的 PER 集体在 30 天全因死亡率和脑血管事件方面显示出更多的术后短期并发症，而 NEO 显示出更高的 PVL 发生率。