title: Transfemorally or transapically deployed Sapien Edwards bioprosthesis is always deformed.
abstract: OBJECTIVE
  To study the impact of femoral compared to apical access on the Sapien-Edwards (SE) prosthesis deployment and geometry in patients treated with transcatheter aortic valve implantation (TAVI) for aortic stenosis.
  
  
  BACKGROUND
  SE prosthesis deformation exists after its deployment through transfemoral (TF-TAVI) approach. However, no study comparing the deformation between TF-TAVI and transapical (TA-TAVI) approaches has yet been published.
  
  
  METHODS
  Forty consecutive patients received TAVI with the SE prosthesis (TF-TAVI n = 25; TA-TAVI n = 15). A fluoroscopic analysis of the prosthesis was then performed. The stent frame geometry was assessed during deployment in the profile view, and after implantation in the profile and frontal views.
  
  
  RESULTS
  Expansion kinetics revealed a triphasic stent deployment with both approaches; the aortic extremity being the first to open. After implantation, on the profile view, the stent shape was never rectangular (therefore never cylindrical) in both groups. It had a biconic shape in most of the patients (76% vs. 93.3% for TF-TAVI and TA-TAVI patients, respectively, P = 0.224) with a wider aortic extremity relative to the ventricular one. The frontal view analysis showed that circular deployment of the stent was never achieved. A greater leaflet to stent mismatch was noted in TA-TAVI patients, however, the difference was not statistically significant (12% vs. 33.3%, P = 0.126).
  
  
  CONCLUSIONS
  Fluoroscopically assessed, the geometry of SE prosthesis was never cylindrical after deployment, whatever the access for implantation was. Longitudinal deformation was greater after TF-TAVI whereas leaflet to stent mismatch tended to be more pronounced after TA-TAVI.
authors: Service de Cardiologie, Université René Descartes, Paris V, AP-HP, Hôpital Européen Georges Pompidou, Paris, France.
authors: Bachir
authors: B
authors: Allam
authors: Rachid
authors: R
authors: Zegdi
authors: Didier
authors: D
authors: Blanchard
authors: Bernard
authors: B
authors: Cholley
authors: Jean-Noël
authors: JN
authors: Fabiani
authors: Antoine
authors: A
authors: Lafont
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000379:methods*; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D005471:Fluoroscopy; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007700:Kinetics; D008297:Male; D008875:Middle Aged