title: Comparison of SAPIEN 3 and SAPIEN XT transcatheter heart valve stent-frame expansion: evaluation using multi-slice computed tomography.
abstract: OBJECTIVE
  Stent-frame morphology of the newer-generation, balloon-expandable transcatheter heart valve (THV), the SAPIEN 3 (S3), after transcatheter aortic valve implantation (TAVI) is unknown. We evaluated the THV stent-frame morphology post TAVI of the S3 using multi-slice computed tomography (MSCT) compared with the prior-generation THV, SAPIEN XT (S-XT).
  
  
  RESULTS
  A total of 94 consecutive participants of RESOLVE registry (NCT02318342) had MSCT after balloon-expandable TAVI (S3 = 39 and S-XT = 55). The morphology of the THV stent-frame was evaluated for expansion area and eccentricity at the THV-inflow, native annulus, mid-THV and THV-outflow levels. Mean %-expansion area for the S3 and the S-XT was 100.9 ± 5.7 and 96.1 ± 5.5%, respectively (P < 0.001). In the S3 group, the THV-inflow level had the largest value of %-expansion area, which decreased from THV-inflow to mid-THV level (105.2 ± 6.4 to 96.5 ± 5.9%, P < 0.001). However, in the S-XT group, %-expansion area increased from THV-inflow level to mid-THV level (93.2 ± 6.2 to 95.1 ± 6.1%, P = 0.0058). On nominal delivery balloon volume, the S3 in 88.5% of cases had overexpansion at the THV-inflow level. The observed degree of THV oversizing of the S3 was significantly lower than the S-XT (6.3 ± 8.6 vs. 11.8 ± 8.5%, P = 0.0027). Nonetheless, the incidence of post-procedural paravalvular aortic regurgitation (PVR) ≥ mild following the S3 TAVI was also significantly lower than the S-XT TAVI (17.9 vs. 43.6%, P = 0.014).
  
  
  CONCLUSIONS
  The newer-generation, balloon-expandable device, the S3, has a flared inflow morphology, whereas the prior-generation device, the S-XT, has relatively constrained inflow morphology post TAVI. This may contribute to a lesser degree of PVR with the S3.
authors.affiliation: Cedars-Sinai Medical Center, Heart Institute, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd, Third Floor, Suite A3414, Los Angeles, CA 90048, USA.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Kazuno
authors.affiliation: Cedars-Sinai Medical Center, Heart Institute, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd, Third Floor, Suite A3414, Los Angeles, CA 90048, USA.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Maeno
authors.affiliation: Cedars-Sinai Medical Center, Heart Institute, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd, Third Floor, Suite A3414, Los Angeles, CA 90048, USA.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kawamori
authors.affiliation: Cedars-Sinai Medical Center, Heart Institute, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd, Third Floor, Suite A3414, Los Angeles, CA 90048, USA.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Takahashi
authors.affiliation: Cedars-Sinai Medical Center, Heart Institute, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd, Third Floor, Suite A3414, Los Angeles, CA 90048, USA.
authors.forename: Yigal
authors.initials: Y
authors.lastname: Abramowitz
authors.affiliation: Cedars-Sinai Medical Center, Heart Institute, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd, Third Floor, Suite A3414, Los Angeles, CA 90048, USA.
authors.forename: Hariri
authors.initials: H
authors.lastname: Babak
authors.affiliation: Cedars-Sinai Medical Center, Heart Institute, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd, Third Floor, Suite A3414, Los Angeles, CA 90048, USA.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Kashif
authors.affiliation: Cedars-Sinai Medical Center, Heart Institute, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd, Third Floor, Suite A3414, Los Angeles, CA 90048, USA.
authors.forename: Tarun
authors.initials: T
authors.lastname: Chakravarty
authors.affiliation: Cedars-Sinai Medical Center, Heart Institute, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd, Third Floor, Suite A3414, Los Angeles, CA 90048, USA.
authors.forename: Mamoo
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Cedars-Sinai Medical Center, Heart Institute, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd, Third Floor, Suite A3414, Los Angeles, CA 90048, USA.
authors.forename: Wen
authors.initials: W
authors.lastname: Cheng
authors.affiliation: Cedars-Sinai Medical Center, Heart Institute, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd, Third Floor, Suite A3414, Los Angeles, CA 90048, USA.
authors.forename: John
authors.initials: J
authors.lastname: Friedman
authors.affiliation: Cedars-Sinai Medical Center, Heart Institute, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd, Third Floor, Suite A3414, Los Angeles, CA 90048, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Berman
authors.affiliation: Cedars-Sinai Medical Center, Heart Institute, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd, Third Floor, Suite A3414, Los Angeles, CA 90048, USA.
authors.forename: Raj R
authors.initials: RR
authors.lastname: Makkar
authors.affiliation: Cedars-Sinai Medical Center, Heart Institute, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd, Third Floor, Suite A3414, Los Angeles, CA 90048, USA hasanjilaihawi@gmail.com.
authors.forename: Hasan
authors.initials: H
authors.lastname: Jilaihawi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000628:therapy*; D001705:Bioprosthesis; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012042:Registries; D018570:Risk Assessment; D015607:Stents; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome
keywords: MSCT; Morphology; SAPIEN 3; SAPIEN XT; TAVI; Transcatheter heart valve expansion