Comparison of acute recoil after valve deployment and after post‐dilation in patients undergoing transfemoral‐transcatheter aortic valve replacement with SAPIEN‐3 valve

Abstract

Background: Transcatheter aortic valves are prone to acute recoil similar to the metal-based coronary stents. However, it is not clear if recoil remains a factor only after the initial valve deployment or also after post-dilation. Methods: We conducted a retrospective observational study of patients who underwent transfemoral transcatheter aortic valve replacement (TAVR) with SAPIEN-3 valve. Acute recoil at the upper, central, and lower levels of the valve was calculated in both anteroposterior right anterior oblique (RAO) and lateral left anterior oblique (LAO) views after initial deployment as well as after post-dilation. The average recoil of the RAO and LAO views was also calculated and described as RAO/LAO. Results: The acute recoil in the RAO/LAO views (mean ± SD) was 3.9 ± 1.1% after valve deployment in the whole study population (n = 257). Among the subset of patients who required post-dilation (n = 133), the mean acute recoil in the RAO/LAO views was found to be greater after initial valve deployment as compared with after post-dilation (3.8 ± 1.1% vs. 3.0 ± 0.9%; p < .001). Further, acute recoil was significantly greater in the RAO view than the LAO view and at the central level of the prosthesis as compared with the upper and lower levels. Those findings were consistent after initial deployment as well as after post-dilation. Clinical outcomes were similar between patients who required post-dilation compared to those who did not. In multivariable logistic regression analysis, only smaller valve cover index was found to be an independent predictor of 30-day mild or greater aortic regurgitation (OR 0.007; 95% CI 0.0001-0.707; p = .035). Conclusion: Acute elastic recoil of the SAPIEN-3 valve was significantly less after post-dilation as compared with after deployment. It was also greater when measured in the RAO view as compared with the LAO view. Furthermore, acute recoil was not homogenous across the height of the valve stent frame.

Acute expansion of nitinol-based self-expandable device in patients undergoing transfemoral aortic valve implantation

“…21,22 Previous studies of acute changes in transcatheter valves after deployment were limited to balloon-expandable devices. 16,17 The acute recoil of balloon-expandable valves was described as greater during the initial deployment compared with postdilation and more evident in the middle part of the stent than in the inflow or outflow. 22 This acute recoil of aortic balloon-expandable valves appears bigger in valves created with the cobalt-chromium frame than in the stainless-steel frame used in the older generation valve.…”

“…Previous studies of acute changes in transcatheter valves after deployment were limited to balloon-expandable devices 16,17 . The acute recoil of balloon-expandable valves was described as greater during the initial deployment compared with postdilation and more evident in the middle part of the stent than in the inflow or outflow 22 .…”

“…14,15 Of interest, it is widely described that TAVR with a balloon-expandable valve was systematically associated with a certain degree of valve stent recoil. 16,17 Conversely, the acute effects of nitinol-based self-expandable valves on postdeployment dimensions have not been reported. Nitinol-based shape memory alloys possess a unique combination of properties, including shape memory, super-elasticity and resistance to fatigue and corrosion.…”

“…Of interest, it is widely described that TAVR with a balloon-expandable valve was systematically associated with a certain degree of valve stent recoil 16,17 . Conversely, the acute effects of nitinol-based self-expandable valves on postdeployment dimensions have not been reported.…”

TAVR prosthesis recoil: Unknowns and implications

“…Sammour and collaborators conducted an observational study of 257 patients who underwent TAVR with SAPIEN‐3 valve 2 . Acute valvular recoil at the upper, central, and lower levels was calculated in both antero‐posterior (RAO) and lateral (LAO) views during initial device deployment and after post‐dilation.…”