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Cleveland, Ohio

Cleveland Clinic. Aatish Garg MD*; Akhil Parashar MD*; Shikhar Agarwal MD MPH; Olcay Aksoy MD; Kanhaiya Poddar MD; Rishi Puri MD; Lars Svensson MD PhD; Amar Krishnaswamy MD; E Murat Tuzcu MD; Samir R Kapadia MD *Dr.Garg and Dr.Parashar contributed equally to this work. Cleveland, Ohio.

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Cleveland, Ohio

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  1. Cleveland Clinic Aatish Garg MD*; Akhil Parashar MD*; Shikhar Agarwal MD MPH; Olcay Aksoy MD; Kanhaiya Poddar MD; Rishi Puri MD; Lars Svensson MD PhD; Amar Krishnaswamy MD; E Murat Tuzcu MD; Samir R Kapadia MD *Dr.Garg and Dr.Parashar contributed equally to this work Cleveland, Ohio Comparison of Acute Elastic Recoil Between the SAPIEN-XT and SAPIEN valves in Transfemoral - Transcatheter Aortic Valve Replacement RESULTS INTRODUCTION RESULTS • SAPIEN-XT is a newer generation balloon-expandable valve with a stent-structure created of cobalt chromium, as opposed to the stainless steel stent used in the older generation SAPIEN valve that was used in TAVR. • We sought to determine if there was difference in acute recoil between the two valves. Table 3: Valve performance and hemodynamic outcomes stratified by valve type.* Table 2: Comparison of recoil in SAPIEN and SAPIEN-XT valves stratified by valve size. Table 1 : Baseline Characteristics AIM • To determine if there is a difference in acute recoil between the two valves types. • To assess if there is a relation of this acute recoil to valve performance. Figure 3 : Two way scatter plot demonstrating correlation between Acute Recoil and Aortic Regurgitation Index. METHODS • All patients who underwent TF-TAVR using the SAPIEN XT valves at Cleveland Clinic until March 2013 were included. • Recoil was measured using biplane cine-angiographic image analysis of valve deployment (Figure1). • Acute recoil was defined as [(valve diameter at maximal balloon inflation)- (valve diameter after deflation)] / valve diameter at maximal balloon inflation (reported as percentage). • Patients undergoing SAPIEN valve implantation were used as the comparison group. • AR index was calculated from the waveform data collected during the procedure. It was defined as (after valve deployment): [ (Diastolic BP- LVEDP) / Systolic BP ]* 100 Figure 4: Multivariable linear regression model demonstrating increased acute recoil in SAPIEN XT valves compared to SAPIEN valves. *All comparisons were statistically non significant. Figure 2 : Comparison of acute recoil (%) between the SAPIEN and SAPIEN-XT valves, stratified by valve size. CONCLUSIONS Figure 1: Cine-angiographic images of valve deployment in the right anterior oblique view • The cobalt-chromium SAPIEN XT valve used for TAVR has a greater tendency to recoil acutely after implantation when compared to the stainless-steel SAPIEN valve, irrespective of size of the prosthesis. • The difference in acute recoil was not predicted by the cover index or the degree of aortic annular calcification. • The SAPIEN XT valve scaffold possesses significantly thinner struts than the SAPIEN valve scaffold, possibly explaining the greater recoil. • There is no difference in AR index score or degree of paravalvular leak at 30 days between these valves. Panel A demonstrates the valve at maximum balloon inflation Panel B demonstrates the valve after the balloon has been deflated.

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