**3.3 ACURATE valve Neo2**

The ACURATE Neo2 valve by Boston Scientific is a porcine tissue pericardial valve with a self-expanding nitinol frame. It is available in 23 mm, 25 mm, and 27 mm sizes and is inserted transfemorally. In a multicenter European study, [38] the ACURATE Neo valve demonstrated good feasibility and early safety in 24 patients with native AR. The device success rate was 87.5%, with 4.1% all-cause mortality at 30 days. Two patients had moderate PVL and three required implantation of a second device for severe PVL and device displacement. The need for new PPM was 21.1% which is higher than the other commercially available TAVR valves. Acurate Neo2 is an investigational device restricted to experimental use in the United States (**Figure 4**) [39].

#### **3.4 ACURATE TA**

The ACCURATE TA device by Symetis, Switzerland, is composed of a selfexpanding nitinol frame and is delivered trans-apically (**Figure 5**). It was explored as a treatment for severe native AR in patients with high surgical risk. A small single-center German case center series demonstrates the feasibility of transapical TAVR with the self-expandable ACURATE TA device in high-risk patients with 100%

**Figure 4.** *ACURATE Neo2 valve with self-expanding nitinol frame (credit: Boston Scientific).*

procedural success and 0% all-cause mortality at 30 days. However, in the current era of transfemoral TAVR, the transapical approach may be considered too invasive [40].
