title: Impact of post-implant SAPIEN XT geometry and position on conduction disturbances, hemodynamic performance, and paravalvular regurgitation.
abstract: OBJECTIVE
  This report sought to study the impact of the balloon-expandable SAPIEN XT (Edwards Lifesciences, Irvine, California) transcatheter heart valve (THV) stent frame geometry and position on outcomes of transcatheter aortic valve replacement (TAVR).
  
  
  BACKGROUND
  Post-implant THV geometry and position might impact atrioventricular conduction, hemodynamic performance, and annular sealing.
  
  
  METHODS
  Eighty-nine consecutive patients who underwent TAVR with a Sapien XT THV had pre- and post-implant multidetector computed tomography, transthoracic echocardiography, and electrocardiograms performed to assess THV stent geometry, atrioventricular conduction, and hemodynamic performance.
  
  
  RESULTS
  The THV Circularity (THV eccentricity <10% [eccentricity = minimum stent diameter/maximum stent diameter]) and under-expansion (THV area/nominal THV area <90%) were present in 97.8% (2 of 89) and 0%, respectively. Low THV implantation was associated with new left bundle branch block and complete heart block (3.4 ± 2.0 mm vs. 5.5 ± 2.9 mm, p = 0.01) and with the need for permanent pacemaker implantation (3.5 ± 2.0 mm vs. 7.1 ± 2.5 mm, p = 0.001). In contrast, labeled THV size and THV area oversizing was not associated with atrioventricular conduction disturbances. The relation between inflow stent frame area and annular area was related to paravalvular regurgitation (p = 0.025). Labeled prosthesis size but not prosthesis expansion or eccentricity was related to valve gradient (p = 0.005) and effective orifice area (p < 0.001).
  
  
  CONCLUSIONS
  Low implantation depth of balloon-expandable THVs is associated with clinically significant new conduction disturbances and permanent pacemaker implantation. Importantly, annular area oversizing was not associated with these complications.
authors.affiliation: St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Ronald K
authors.initials: RK
authors.lastname: Binder
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
authors.forename: Stefan
authors.initials: S
authors.lastname: Toggweiler
authors.forename: Melanie
authors.initials: M
authors.lastname: Freeman
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Willson
authors.forename: Donya
authors.initials: D
authors.lastname: Alhassan
authors.forename: Cameron J
authors.initials: CJ
authors.lastname: Hague
authors.forename: David A
authors.initials: DA
authors.lastname: Wood
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D002304:Cardiac Pacing, Artificial; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006327:Heart Block / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006329:Heart Conduction System / Q000503:physiopathology; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome