title: Transcatheter aortic valve implantation with the new balloon-expandable Sapien 3 versus Sapien XT valve system: a propensity score-matched single-center comparison.
abstract: BACKGROUND
  The new balloon-expandable Sapien 3 transcatheter heart valve (S3-THV) incorporates new features to reduce aortic regurgitation (AR) and vascular complications in transcatheter aortic valve implantation. Aim of this study is to compare the outcomes of the S3-THV with the preceding Sapien XT THV (SXT-THV) in patients who underwent transcatheter aortic valve implantation for symptomatic severe native aortic stenosis.
  
  
  RESULTS
  Eligible patients were retrospectively identified in our institutional database and periprocedural clinical and imaging data were collected. Non-parsimonious one-to-many propensity score matching was performed to account for differences in baseline characteristics. Between November 2011 and December 2014, 167 patients underwent balloon-expandable transcatheter aortic valve implantation with either the S3-THV (n=49) or SXT-THV (n=118). Forty-four (89.8%) S3-THV patients were matched to 66 (55.9%) SXT-THV patients (mean age 80.3±8.4 and 80.5±7.8 years, median EuroSCORE 15.8 and 16.5%, respectively). In the S3-THV and SXT-THV groups, transfemoral approach (77.3% versus 78.8%) and postdilatation rates (15.9% versus 12.1%) were similar. Predischarge echocardiography demonstrated a lower incidence of ≥mild AR (15.9% versus 46.2%, P=0.003) for the S3-THV, despite reduced annulus area to prosthesis oversizing (8.2±5.1 versus 18.2±10.7%, P=0.001). Transfemoral access site-related life-threatening or major bleedings and vascular complications were absent in the S3-THV group (0% versus 7.7%, P=0.15). No differences were observed in pacemaker implantation rate (9.8% versus 8.8%, P=0.94) and 30-day mortality (both 5%).
  
  
  CONCLUSIONS
  In this retrospective, propensity score-matched analysis, the S3-THV performed superiorly to the SXT-THV, as demonstrated by improved valve patency and increased transfemoral access safety.
authors.affiliation: From the Departments of Cardiology (F.N., M.A., P.A., P.A.D., P.R.S.) and Cardiothoracic Surgery (F.Z.R.), University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Freek
authors.initials: F
authors.lastname: Nijhoff
authors.affiliation: From the Departments of Cardiology (F.N., M.A., P.A., P.A.D., P.R.S.) and Cardiothoracic Surgery (F.Z.R.), University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Masieh
authors.initials: M
authors.lastname: Abawi
authors.affiliation: From the Departments of Cardiology (F.N., M.A., P.A., P.A.D., P.R.S.) and Cardiothoracic Surgery (F.Z.R.), University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Agostoni
authors.affiliation: From the Departments of Cardiology (F.N., M.A., P.A., P.A.D., P.R.S.) and Cardiothoracic Surgery (F.Z.R.), University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Faiz Z
authors.initials: FZ
authors.lastname: Ramjankhan
authors.affiliation: From the Departments of Cardiology (F.N., M.A., P.A., P.A.D., P.R.S.) and Cardiothoracic Surgery (F.Z.R.), University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Pieter A
authors.initials: PA
authors.lastname: Doevendans
authors.affiliation: From the Departments of Cardiology (F.N., M.A., P.A., P.A.D., P.R.S.) and Cardiothoracic Surgery (F.Z.R.), University Medical Center Utrecht, Utrecht, Netherlands. p.stella@umcutrecht.nl.
authors.forename: Pieter R
authors.initials: PR
authors.lastname: Stella
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D057216:Propensity Score; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000295:instrumentation*
keywords: aortic regurgitation; aortic valve stenosis; transcatheter aortic valve implantation; vascular complications