Procedural and Hemodynamic Outcomes of Contemporary Self-Expanding Valves for Transcatheter Aortic Valve Replacement: A Multicenter Comparison From the AMTRAC Registry.

Background: Comparative data among contemporary self-expanding transcatheter heart valve designs remain limited. We compared clinical and hemodynamic outcomes following transcatheter aortic valve replacement using 2 leading contemporary platforms. Methods: This multicenter cohort study utilized the AMTRAC registry to evaluate consecutive patients treated with either Evolut PRO/PRO+/FX or Navitor. The primary analysis employed a 1:1 propensity score-matched cohort, utilizing multilevel mixed-effects models to adjust for center-level clustering. The primary endpoint was 1-year all-cause mortality. Results: Of 2673 patients, propensity score matching yielded a balanced cohort of 1200 patients. At 1-year, all-cause mortality was similar between groups (Navitor: 7.1% vs. Evolut: 9.2%; hazard ratio 0.75; 95% CI: 0.47-1.21; Conclusions: Contemporary self-expanding platforms demonstrate comparable 1-year mortality and stroke rates. Periprocedural vascular and bleeding safety profiles are strongly modulated by center-specific clustering and practice variations. Conversely, the superior hemodynamic performance of the Evolut platform remains independent of institutional factors. These findings support an anatomy-driven approach to valve selection integrating patient profiles with institutional practices.