Incidence, predictive factors and haemodynamic consequences of acute stent recoil following transcatheter aortic valve implantation with a balloon-expandable valve

Nombela‐Franco, Luis; Ribeiro, Henrique Barbosa; Ureña, Marina; Pasian, Sergio; Allende, Ricardo; Doyle, D. John; DeLarochellière, Robert; DeLarochellière, Hugo; Laflamme, Louis; Laflamme, Jérôme; Jerez-Valero, Miguel; Côté, Mélanie; Larose, Éric; Dumont, Éric; Rodés‐Cabau, Josep

doi:10.4244/eijv9i12a237

Cited by 15 publications

(18 citation statements)

References 25 publications

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“…Studies have shown an average 3.75–5.18% of acute recoil associated with the SAPIEN XT valve depending on the valve size or the study [7, 8]. This case report shows late recoil as the likely mechanism for progression of PVL during follow-up after a 26-mm SAPIEN XT implantation and in summation shows 7.07–9.25% of acute plus late recoil at different valve levels at 1 year of follow-up.…”

Section: Resultsmentioning

confidence: 62%

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Late Paravalvular Aortic Regurgitation: Migration of the Valve or Late Recoil?

et al. 2017

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A 79-year-old man underwent trans-catheter aortic valve replacement for symptomatic severe aortic stenosis with a 26-mm Edwards SAPIEN XT valve. Immediately after valve deployment there was moderate amount of paravalvular leak. Post-dilation was performed with an additional 2 cc of volume, and the paravalvular leak was reduced to trace. Nine months later, trans-thoracic echocardiography revealed moderate to severe paravalvular leak and possible aortic migration of the valve. The patient was brought back for the treatment of the paravalvular leak which was suspected to be due to valve migration. However, fluoroscopy and trans-esophageal echocardiography showed good valve position. Measurement of late valve recoil in the Coplanar view using cine-angiographic analysis software showed that the lower third of the valve had the greatest late recoil (−1.74 mm, 6.55%), which presumably accounted for the progression of the paravalvular leak. Valve-in-valve trans-catheter aortic valve replacement was performed with a 26-mm SAPIEN 3 valve and the paravalvular leak was reduced to trace. This case displays late recoil as a likely mechanism for development of paravalvular leak after SAPIEN XT valve implantation. Our case illustrates that late recoil needs to be systematically evaluated in future studies, especially when trans-catheter aortic valve replacement is being expanded to lower risk and younger patients for whom the longevity and long-term performance of these valves is of critical importance.

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Section: Resultsmentioning

confidence: 62%

“…Both studies only included the first-generation SAPIEN valve and the second-generation SAPIEN XT valve, and both reported higher degree of acute recoil with the SAPIEN XT valve [7, 8]. …”

Section: Discussionmentioning

confidence: 99%

Late Paravalvular Aortic Regurgitation: Migration of the Valve or Late Recoil?

et al. 2017

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“…It has been postulated that complete or underexpansion of THV may also be related to the annular size, extent of aortic valve calcification, THV stent recoil, or inadequate THV balloon expansion (under-filling or over-filling delivery balloon volume and short or long duration of balloon expansion). 18 , 19 However, our study showed that aortic valve calcium distribution and LVOT calcium were not significantly different between the S3 and the S-XT groups ( Tables 2 and 6 ), suggesting the critical difference to be device driven.…”

Section: Discussionmentioning

confidence: 61%

“…The correlation between expansion area of the THV and delivery balloon volume on prior-generation, balloon-expandable THV (S-XT) has been described in one other study. Barbanti et al 18 analysed 134 patients with severe aortic stenosis who underwent TAVI with the S-XT. Nominally filled delivery balloon volume resulted in a prosthesis cross-sectional CT area that correlated well with the expected THV area.…”

Section: Discussionmentioning

confidence: 99%

Comparison of SAPIEN 3 and SAPIEN XT transcatheter heart valve stent-frame expansion: evaluation using multi-slice computed tomography

Kazuno

Maeno

Kawamori

et al. 2016

Eur Heart J Cardiovasc Imaging

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AimsStent-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).Methods and resultsA 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).ConclusionThe 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.

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“…A previous study has shown that excessive oversizing and XT valve both predicted a larger degree of stent recoil. 21) Accordingly, for XT prosthesis, there is an increased calcified space that remains between the aortic annular wall and the prosthesis. This space allows blood to regurgitate through incomplete apposition.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter Aortic Valve Implantation With Different Valve Designs for Severe Device Landing Zone Calcification

Maeno¹,

Abramowitz²,

Kazuno³

et al. 2017

Int. Heart J.

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SummarySevere device landing zone calcification (DLZ-CA) predicted paravalvular leak (PVL) and post-dilatation (PD) after transcatheter aortic valve implantation (TAVI). The aim of this study was to determine the influence of DLZ-CA on PVL or PD rates after SAPIEN XT (XT) versus CoreValve (CV).We analyzed patients undergoing TAVI who had severe DLZ-CA. Severe DLZ-CA defined the upper left ventricular outflow tract calcification; the cross-sectional region 2 mm inferior to the annular plane. PVL was evaluated at 30-days using transthoracic echocardiography. Overall, 133 patients had XT-TAVI and the remaining 41 patients had CV-TAVI. Two patients had annulus injury in the XT group (oversizing 20.2% and 20.5% for two XT cases). PD was less frequently performed in the XT group (34.1% versus 12.8%; P = 0.002), but PVL rates were similar between both groups (42.1% versus 41.5% for the XT and CV groups, respectively; P = 0.94). Importantly, excessive oversizing or the degree of filling volume was not associated with decreased PVL after XT-TAVI (P = non-significant for all). On multivariate analysis, CV-TAVI was found to be one of the independent predictors of need for PD (Odds ratio 3.63, 95% confidence interval 1.55 to 8.53, P = 0.003).In the setting of severe DLZ-CA, XT and CV have similar rates of PVL but XT had less need for PD. Excessive oversizing with XT carries a risk of root injury which could be further increased by DLZ-CA. (Int Heart J 2017; 58: 56-62)

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Incidence, predictive factors and haemodynamic consequences of acute stent recoil following transcatheter aortic valve implantation with a balloon-expandable valve

Cited by 15 publications

References 25 publications

Late Paravalvular Aortic Regurgitation: Migration of the Valve or Late Recoil?

Late Paravalvular Aortic Regurgitation: Migration of the Valve or Late Recoil?

Comparison of SAPIEN 3 and SAPIEN XT transcatheter heart valve stent-frame expansion: evaluation using multi-slice computed tomography

Transcatheter Aortic Valve Implantation With Different Valve Designs for Severe Device Landing Zone Calcification

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