Portico at 1 Year
“There is Nothing Like First-Hand Evidence”
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Gurpreet S. Sandhu, MD, PhD; Charanjit S. Rihal, MD
—Sir Arthur Conan Doyle. A Study in Scarlet, 1887
Long awaited, the St Jude Medical (St Paul, MN) Portico valve is a self-expanding percutaneous aortic valve prosthesis consisting of a Nitinol cage and leaflets made of bovine pericardium. Potential advantages of its design include large stent cell sizes and a relatively shorter height with minimal flaring, designed to prevent deep placement in the left ventricular outflow tract and lower pacemaker rates. In this issue of Circulation: Cardiovascular Interventions, Linke et al1 present 1-year outcomes from the Portico prospective, multicenter registry (ClinicalTrials.gov, NCT01493284). A total of 222 patients with severe aortic stenosis and a mean age of 83 years (74% women) were enrolled in Europe and Australia, with the primary end point of all-cause 30-day mortality. Inclusion and exclusion criteria, as well as study design, are similar to previous intermediate and high-risk transcatheter aortic valve replacement (TAVR) trials, with an Society of Thoracic Surgery (STS) risk2 requirement of ≥4. Patients with a lower STS risk score but deemed inoperable or high risk by the heart team were also included. A high proportion, one third, of valves required recapture and repositioning during the procedure. The implanted valves included an equal …