Transcatheter Aortic Valve Replacement Using the Portico System: 10 Things to Remember

Amrane, Hafid; Bedogni, Francesco; Brambilla, Nedy; Kefer, Joëlle; Manoharan, Ganesh; Makkar, Raj; Möllman, Helge; Rodés‐Cabau, Josep; Schäfer, Ulrich; Settergren, Magnus; Spargias, Konstantinos; Boven, Ad van; Walther, Thomas; Worthley, Stephen G.; Søndergaard, Lars

doi:10.1111/joic.12322

Cited by 20 publications

(13 citation statements)

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“…The Portico valve has been introduced into clinical practice several years ago, and it has been refined over the years to improve deliverability and mitigate the risk of paravalvular leak [ 25 ]. Indeed, it is now considered a valid alternative to other established devices for TAVI, such as Sapien (Edwards Lifesciences, Irvine, CA, USA), and Evolut (Medtronic, Minneapolis, MN, USA) [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes following transcatheter aortic valve implantation with the Portico self-expanding valve

et al. 2023

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Aim Transcatheter aortic valve implantation (TAVI) is a mainstay in the management of severe aortic valve stenosis in elderly patients, but there is uncertainty on their long-term effectiveness. We aimed to assess the long-term outcome of patients undergoing TAVI with the Portico valve. Methods We retrospectively collected the data on patients in whom TAVI with Portico was attempted from 7 high-volume centres. Only patients theoretically eligible for 3 or more years of follow-up were included. Clinical outcomes, including death, stroke, myocardial infarction, reintervention for valve degeneration and hemodynamic valve performance were systematically assessed. Results A total of 803 patients were included, with 504 (62.8%) women, mean age of 82 years, median EuroSCORE II of 3.1%, and 386 (48.1%) subjects at low/moderate risk. The median follow-up was 3.0 years (3.0; 4.0). The composite of death, stroke, myocardial infarction, and reintervention for valve degeneration occurred in 37.5% (95% confidence interval: 34.1–40.9%), with all-cause death in 35.1% (31.8–38.4%), stroke in 3.4% (1.3–3.4%), myocardial infarction in 1.0% (0.3–1.5%), and reintervention for valve degeneration in 1.1% (0.6–2.1%). The mean aortic valve gradient at follow-up was 8.1 ± 4.6 mmHg, and at least moderate aortic regurgitation was present in 9.1% (6.7–12.3%). Independent predictors of major adverse events or death were: peripheral artery disease, chronic obstructive pulmonary disease, estimated glomerular filtration rate, atrial fibrillation, prior pacemaker implantation, EuroSCORE II, and reduced left ventricular ejection fraction (all p < 0.05). Conclusions Portico use is associated with favorable long-term clinical outcomes. Clinical outcomes were largely impacted by baseline risk factors and surgical risk.

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Section: Discussionmentioning

confidence: 99%

Long-term outcomes following transcatheter aortic valve implantation with the Portico self-expanding valve

et al. 2023

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“…For Portico, optimal implantation depth is represented by the frame's inflow edge placed 3–4 mm below the aortic annulus (range 1–9 mm for 23/25 mm valves and 1–10 mm for 27/29 mm valves) 9 …”

Section: Methodsmentioning

confidence: 99%

“…Technical details of each prosthesis have been described previously. [9][10][11] Implantation depth was defined as the maximal distance between the intraventricular edge of the bioprosthesis and the aortic annulus at the level of the noncoronary cusp and left coronary cusp, as measured by angiography in the projection chosen for deployment. 12 For Portico, optimal implantation depth is represented by the frame's inflow edge placed 3-4 mm below the aortic annulus (range 1-9 mm for 23/25 mm valves and 1-10 mm for 27/29 mm valves).…”

Section: Tavimentioning

confidence: 99%

“…12 For Portico, optimal implantation depth is represented by the frame's inflow edge placed 3-4 mm below the aortic annulus (range 1-9 mm for 23/25 mm valves and 1-10 mm for 27/29 mm valves). 9 For Evolut-R, optimal implantation depth is represented by the frame's inflow edge placed 3-5 mm below the aortic annulus. 10 For Acurate NEO, optimal implantation depth is represented by the lower crown's inflow edge ≤7 mm below the aortic annulus.…”

Section: Tavimentioning

confidence: 99%

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Impact of aortic angle on transcatheter aortic valve implantation outcome with Evolut‐R, Portico, and Acurate‐NEO

Gorla

Marco

Garatti

et al. 2020

Cathet Cardio Intervent

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Objectives: To investigate paravalvular leak (PVL) and devices success rates according to aortic angle (AA) in patients undergoing transcatheter aortic valve implantation (TAVI) with three new-generation self-expanding devices. Background: The impact of aortic angle (AA) on TAVI device success and PVL rates is controversial. Methods: This retrospective study included 392 patients submitted to TAVI for severe aortic stenosis with Portico, Evolut-R and Acurate-NEO, and available AA measurements at computed tomography (CT) angiography. AA was calculated from the implantation projection and was defined as the angle between the plane of aortic annulus and an ideal horizontal plane. Aorta was defined horizontal if AA>57 (75th percentile). Results: In the horizontal group, the rates of moderate/severe PVL was higher in the Evolut-R group (20.8%), which was also characterized by a lower implant compared to that of Acurate-NEO, whereas device success was comparable among the three devices. AA was a significant predictor of moderate/severe PVLs (AUC 0.72, p = .002) only in the Evolut-R population. On multivariate analysis, calcium volume 850HU, bicuspid aortic valve, and implantation depth at the level of left coronary cusp were independent predictors of moderate/ severe PVL. On univariate analysis in the horizontal aorta population, implantation depth was confirmed among the most significant predictors of moderate/severe PVL. Conclusions: Despite comparable device success rates, horizontal aorta represented a technical challenge only in the Evolut-R subgroup, which showed higher rates of moderate/severe PVL than Portico and Acurate-NEO, and was associated with a low implant.

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“…The system is fully resheathable, if not completely released, to achieve the optimal position in order to minimize paravalvural leaks and avoid pop-outs. The Portico valve is available in four sizes, 23 mm, 25 mm, 27 mm, and 29 mm, and has been described in detail previously [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

Transcatheter Aortic Valve Implantation with the Portico Valve: 2-Year Outcomes of a Multicenter, Real-World Registry

Didagelos,

Ninios,

Kakderis

et al. 2023

Life

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Introduction: The self-expanding, resheathable, repositionable transcatheter aortic heart valve Portico is being used successfully for transcatheter aortic valve implantation procedures (TAVI) in patients with severe aortic stenosis. The aim of this study was to evaluate outcomes at 2 years after TAVI with the Portico valve. Methods: Multicenter registry of clinical, echocardiographic and survival data from consecutive patients treated with the Portico TAVI system (Abbott, Chicago, IL, USA) in three cath labs in Northern Greece and Epirus during 2017–2020. The primary end point was all-cause mortality at 24 months. Secondary end points included procedural outcomes (efficacy and safety) and echocardiographic measurements. Results: A total of 90 patients (81 ± 6 years, 50% females, mean age 81 ± 6 years) were included in the registry. The indication for implantation was severe, symptomatic aortic stenosis (NYHA III, IV) in eighty-two (91.1%) and degeneration of a prosthetic aortic valve in eight (8.9%) patients. All patients were categorized as high surgical risk (mean Logistic Euroscore 25.9 ± 10, Euroscore II 7.7 ± 4.4 and STS score 10.8 ± 8.9). The procedure was performed transfemorally in all patients, under general anesthesia in 95.6%, under TOE guidance in 21.1%, with native valve predilatation in 46.7%, and the “resheath” option was used in 31.1% of the cases. The implantation was successful in 97.8% and there was a need for a second valve in 2.2% of the cases. Complications included permanent pacemaker implantation (16.7%), access cite complications (15.6%), arrythmias (23.3%), paravalvular leak (moderate 7.8%, severe 1.1%), acute kidney injury (7.8%), no strokes and one death during the procedure. Aortic valve peak velocity, peak and mean pressure gradients, were significantly reduced after the procedure. All-cause mortality at 1, 12 and 24 months was 4.4%, 6.7% and 7.8%, respectively. Conclusions: TAVI with the Portico system comprises an effective and safe solution for the management of severe, symptomatic aortic stenosis in high-risk surgical patients.

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Transcatheter Aortic Valve Replacement Using the Portico System: 10 Things to Remember

Cited by 20 publications

References 2 publications

Long-term outcomes following transcatheter aortic valve implantation with the Portico self-expanding valve

Long-term outcomes following transcatheter aortic valve implantation with the Portico self-expanding valve

Impact of aortic angle on transcatheter aortic valve implantation outcome with Evolut‐R, Portico, and Acurate‐NEO

Transcatheter Aortic Valve Implantation with the Portico Valve: 2-Year Outcomes of a Multicenter, Real-World Registry

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