Comparison of SAPIEN 3 and SAPIEN XT transcatheter heart valve stent-frame expansion: Evaluation using multi-slice computed tomography

Yoshio Kazuno, Yoshio Maeno, Hiroyuki Kawamori, Nobuyuki Takahashi, Yigal Abramowitz, Hariri Babak, Mohammad Kashif, Tarun Chakravarty, Mamoo Nakamura, Wen Cheng, John Friedman, Daniel Berman, Raj R. Makkar, Hasan Jilaihawi

Research output: Contribution to journalArticlepeer-review

37 Scopus citations

Abstract

Aims Stent-frame morphology of the newer-generation, balloon-expandable transcatheter heart valve (THV), the SAPIEN 3 (S3), after transcatheter aortic valve implantation (TAVI) is unknown.We evaluated the THV stent-frame morphology post TAVI of the S3 using multi-slice computed tomography (MSCT) compared with the prior-generation THV, SAPIEN XT (S-XT). Methods and results A total of 94 consecutive participants of RESOLVE registry (NCT02318342) had MSCT after balloon-expandable TAVI (S3 39 and S-XT 55). The morphology of the THV stent-frame was evaluated for expansion area and eccentricity at the THV-inflow, native annulus, mid-THV and THV-outflow levels. Mean %-expansion area for the S3 and the S-XT was 100.9+5.7 and 96.1+5.5%, respectively (P , 0.001). In the S3 group, the THV-inflow level had the largest value of %-expansion area, which decreased from THV-inflow to mid-THV level (105.2+6.4 to 96.5+5.9%, P , 0.001). However, in the S-XT group, %-expansion area increased from THV-inflow level to mid-THV level (93.2+6.2 to 95.1+6.1%, P 0.0058). On nominal delivery balloon volume, the S3 in 88.5% of cases had overexpansion at the THV-inflow level. The observed degree of THV oversizing of the S3 was significantly lower than the S-XT (6.3+8.6 vs. 11.8+8.5%, P 0.0027). Nonetheless, the incidence of post-procedural paravalvular aortic regurgitation (PVR) ? mild following the S3 TAVI was also significantly lower than the S-XT TAVI (17.9 vs. 43.6%, P 0.014). Conclusion The newer-generation, balloon-expandable device, the S3, has a flared inflow morphology, whereas the prior-generation device, the S-XT, has relatively constrained inflow morphology post TAVI. This may contribute to a lesser degree of PVR with the S3.

Original languageEnglish
Pages (from-to)1054-1062
Number of pages9
JournalEuropean Heart Journal Cardiovascular Imaging
Volume17
Issue number9
DOIs
StatePublished - 1 Sep 2016
Externally publishedYes

Keywords

  • MSCT
  • Morphology
  • SAPIEN 3
  • SAPIEN XT
  • TAVI
  • Transcatheter heart valve expansion

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