Safety, effectiveness and haemodynamic performance of a new stented aortic valve bioprosthesis

Robert J M Klautz, A Pieter Kappetein, Rüdiger Lange, Francois Dagenais, Louis Labrousse, Vinayak Bapat, Michael Moront, Martin Misfeld, Cathy Zeng, Joseph F Sabik Iii, PERIGON Investigators, Robert J M Klautz, A Pieter Kappetein, Rüdiger Lange, Francois Dagenais, Louis Labrousse, Vinayak Bapat, Michael Moront, Martin Misfeld, Cathy Zeng, Joseph F Sabik Iii, PERIGON Investigators

Abstract

Objectives: We assessed the safety, effectiveness and haemodynamic performance of a new bovine stented aortic valve bioprosthesis (Avalus™).

Methods: The PERIGON Pivotal Trial is a prospective, non-randomized, multicentre study. Subjects had symptomatic moderate or severe aortic stenosis or chronic, severe aortic regurgitation. Death, valve-related adverse events (AEs), functional recovery and haemodynamic performance were assessed at discharge, 3-6 months and 1 year. The primary analysis compared 'late' (>30 days post-implant) linearized rates of valve-related thromboembolism, thrombosis, all and major haemorrhage, all and major paravalvular leak (PVL) and endocarditis after implantation with objective performance criteria (OPC) for AEs, in accordance with EN ISO 5840:2009. We hypothesized that the upper 95% confidence bounds of the true linearized AE rates would be ≥ 2 × OPC; rejection of the null hypothesis would demonstrate that these rates were below acceptable rates. The analysis was required to include at least 150 patients followed to 1 year and 400 valve-years. Kaplan-Meier survival analysis was also performed.

Results: Total number of valve-years was 459.5 (n = 686). Linearized rates were <2 × OPC for death and valve-related thromboembolism, valve thrombosis, all and major PVL, and endocarditis, but ≥2 × OPC for all and major haemorrhage. Survival at 1 year (n = 270) was 96.4%. Patients showed good functional recovery, and haemodynamic performance was within expected range.

Conclusions: This analysis demonstrated a good safety profile and clinical effectiveness of the Avalus valve except for bleeding rates. The linearized rates of all and major haemorrhage may be related to long-term anticoagulation for non-valvular indications and the length of follow-up of this cohort.

Trial registration: NCT02088554 (www.clinicaltrials.gov).

Keywords: Aortic stenosis; Aortic valve haemodynamics; Aortic valve replacement; Avalus valve; Bioprosthetic valves; Bovine pericardial valves.

© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.

Figures

Figure 1
Figure 1
Photograph and schematic of the Avalus bovine pericardial aortic bioprosthesis. AOA, alpha-amino oleic acid [6]; PEEK, polyether ether ketone.
Figure 2
Figure 2
Patient disposition from screening through 1-year follow-up evaluation.
Figure 3
Figure 3
Valve-related late adverse events (>30 days to 1 year) compared with 2× objective performance criteria (OPC). Error bars indicate 95% upper bound of late linearized rate for each event.
Figure 4
Figure 4
New York Heart Association (NYHA) classification from baseline through 1-year follow-up evaluation.
Figure 5
Figure 5
Haemodynamic performance from baseline through 1-year follow-up evaluation.

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Source: PubMed

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