Comparison of Acute Elastic Recoil in the Sapien-3 Valve After Deployment and After Post-dilation in Transfemoral-Transcatheter Aortic Valve Replacement

Sammour, Yasser

Comparison of Acute Elastic Recoil in the Sapien-3 Valve After Deployment and After Post-dilation in Transfemoral-Transcatheter Aortic Valve Replacement

Tuesday, May 21, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Yasser M Sammour, MD , Cleveland Clinic Foundation, Cleveland, OH

Manpreet Kaur, MD , Cleveland Clinic Foundation, Cleveland, OH

Amer Kadri, MD , Cleveland Clinic Foundation, Cleveland, OH

Antonette K Karrthik, MD , Cleveland Clinic Foundation, Cleveland, OH

Keerat R Ahuja, MD , Cleveland Clinic Foundation, Cleveland, OH

Kamalpreet Dhaliwal, MD , Cleveland Clinic Foundation, Cleveland, OH

Mohamed M Gad, MD , Cleveland Clinic Foundation, Cleveland, OH

Kinjal Banerjee, MD , Cleveland Clinic Foundation, Cleveland, OH

Jeffrey Edward Rossi, M.D. , Cleveland Clinic, Avon

Najdat Bazarbashi, M.D. , Cleveland Clinic Foundation, Cleveland, OH

Muhammad Furqan, MD , Cleveland Clinic Foundation, Cleveland, OH

Lars G. Svensson, M.D. , Cleveland Clinic

Stephanie L Mick, MD , Cleveland Clinic Foundation, Cleveland, OH

Jose L Navia, MD , Cleveland Clinic Foundation, Cleveland, OH

Shinya Unai, MD , Cleveland Clinic Foundation, Cleveland, OH

Grant W Reed, MD , Cleveland Clinic Foundation, Cleveland, OH

Amar Krishnaswamy, M.D. , Cleveland Clinic, Cleveland, OH

Samir Ramesh Kapadia, M.D., FSCAI , Cleveland Clinic, Cleveland, OH

Background
Sapien-3 is the balloon-expandable valve of choice in transcatheter aortic valve replacement (TAVR). The valve’s structure is comprised of a cobalt chromium frame and bovine pericardial tissue leaflets. Post-dilation is performed in some cases to minimize the paravalvular leak. We sought to determine the difference between acute elastic recoil after valve deployment and after post-dilation.

Methods
Consecutive patients undergoing transfemoral-TAVR using the Sapien-3 valve in the biplane hybrid room at the Cleveland Clinic were included. Patients with prior prosthetic aortic valves were excluded. We measured the valve diameters at 3 different levels of the stent frame: 1- upper (aortic), 2- central, and 3- lower (ventricular) at maximal balloon inflation and after deflation during valve deployment and similarly during post-dilation using biplane anterior/posterior (RAO) and lateral (LAO) cine-angiographic image analysis. Acute recoil (%) was defined as: [(valve diameter at maximal balloon inflation) – (valve diameter after deflation)] *100 / (valve diameter at maximal balloon inflation).

Results
Among the total study population (N=257); 57% were males, the mean age (± standard deviation SD) was 80 ± 8.4 years and 133 patients (51.8%) required post-dilation. Overall, the mean acute recoil (± SD) was 3.9 ± 1.1% after valve deployment in all patients, with greater acute recoil in the anterior/posterior dimension measured in the RAO projection as compared with the side-to-side dimension measured in the LAO projection; 4.6 ± 1.9% vs. 3.2 ± 1.4%; p <0.001. Among the patients who required post-dilation, the mean acute recoil was 3.8 ± 1.1% after valve deployment as compared with 3.0 ± 0.9% after post-dilation; p <0.001. Interestingly, valve cover index, valve size and inflation volume did not predict acute recoil in our patients.

Conclusions
Acute recoil in the Sapien-3 valve was found to be significantly less after post-dilation as compared with after valve deployment. Further, biplane imaging demonstrated significantly greater acute recoil in the RAO projection as compared with the LAO projection. Clinical implications of these findings need further investigation.