title: Optimized Implantation Height of the Edwards SAPIEN 3 Valve to Minimize Pacemaker Implantation After TAVI.
abstract: OBJECTIVE
  The transcatheter aortic valve SAPIEN 3 aims at reducing paravalvular leakage (PVL). The new design with outer sealing cuff may increase the risk of permanent pacemaker implantation (PPM). The aim of our study was to evaluate the optimal implantation height of the SAPIEN 3.
  
  
  RESULTS
  We analysed the correlation between the implantation height of the valve and the need for PPM in 131 patients. The PPM rate for the entire group after TAVI was 18% (n = 24). In patients with a marker distance <2 mm ("low implantation"), the PPM rate was 32%, whereas in patients with a distance ≥2 mm ("high implantation"), the rate was only 4.7% (OR of 0.1 (0.03-0.37, P < 0.001)).
  
  
  CONCLUSIONS
  The risk of periprocedural PPM with the Edwards SAPIEN 3 depends on implantation height; it is increased when using conventional implantation techniques. This risk can be minimized below 5% PPM by choosing a higher implantation technique with the central marker 2 mm or more over the annulus plane.
authors.affiliation: Medizinische Klinik für Kardiologie und Angiologie, Campus MitteCharité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Marius
authors.initials: M
authors.lastname: Schwerg
authors.affiliation: Medizinische Klinik für Kardiologie und Angiologie, Campus MitteCharité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Fulde
authors.affiliation: Medizinische Klinik für Kardiologie und Angiologie, Campus MitteCharité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Henryk
authors.initials: H
authors.lastname: Dreger
authors.affiliation: Medizinische Klinik für Kardiologie und Angiologie, Campus MitteCharité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Wolfram C
authors.initials: WC
authors.lastname: Poller
authors.affiliation: Medizinische Klinik für Kardiologie und Angiologie, Campus MitteCharité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Stangl
authors.affiliation: Medizinische Klinik für Kardiologie und Angiologie, Campus MitteCharité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Laule
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery; D019544:Equipment Failure Analysis; D005260:Female; D005858:Germany; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011474:Prosthesis Design; D017755:Prosthesis Fitting / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome