CONGRESS ABSTRACT

INTRODUCTION Transcatheter Aortic Valve Replacement (TAVR) is becoming the standard of care in the modern era of cardiac surgery to treat patients with aortic valve disease. Continuous technological improvement has recently introduced the fifth-generation of the self-expanding Medtronic platform. The aim of the study was to compare the early outcomes of fifth generation (Evolut FX/FX+) Vs previous generation (Evolut PRO/PRO+) of Medtronic TAVR.METHODS: A single-center retrospective analysis was conducted on 882 TAVR perfomed by our Cardiac Surgery Transcatheter Team between 2018 and 2025. Patients who had undergone a Self-Expanding valve implantation with Medtronic platform were enrolled. Cusp overlap technique was adopted routinely in 2021; patients treated before were excluded. RESULTS: In the Evolut PRO/PRO+ group, 62.8% of patients were female compared with 71.5% in the Evolut FX/FX+ group. Bicuspid aortic valve was present in 3.5% of Evolut PRO/PRO+ cases versus 5.8% of Evolut FX/FX+ cases (p=0.53), while valve-in-valve (ViV) procedures were performed in 12.9% vs. 11.5%, respectively (p=0.81).Baseline conduction disorders were similar: right bundle branch block (RBBB) and first-degree atrioventricular (AV) block were present in 10.6% and 4.7% of Evolut PRO/PRO+ patients versus 7.7% (p=0.57) and 5.8% in the Evolut FX/FX+ group. Pre-implant valvuloplasty and post-dilatation were performed in 61.2% and 24.7% of PRO/PRO+ cases vs. 67.3% (p=0.47) and 25% (p=0.97) of FX/FX+ cases, respectively. Postoperatively, permanent pacemaker implantation (PPI) occurred in 9.4% of PRO/PRO+ cases vs. 3.8% of FX/FX+ cases (p=0.22). Left bundle branch block (LBBB) occurred in 15.3% vs. 7.7% of cases, respectively (p=0.19). At 30-day echocardiography, paravalvular leak (PVL) ≥2+ was observed in 8.2% of PRO/PRO+ patients vs. 3.8% of FX/FX+ patients (p=0.31). Thirty-day cardiovascular mortality was 1.1% in the PRO/PRO+ group vs. 0% in the fifth-generation group (p=0.43). CONCLUSIONS:The fifth generation of Medtronic platform (Evolut FX/ FX+) provided good clinical outcome with 0% 30-day mortality. The Evolut FX/FX+ group has shown a trend of lower adverse events: reduced incidence of permanent PM implantation, reduced incidence of para-valvular leak (PVL) ≥ 2+, no cases of severe PVL at 30-day echo. The presence of radio-opaque markers leads to a more precise implantation depth, decreasing the risk of new-onset heart block.