Overexpansion of the SAPIEN 3 Transcatheter Heart Valve

A match not made in heaven—TAVR prosthesis‐patient mismatch with contemporary valves

“…The results, that moderate PPM was present in 25% and severe PPM in 12% are similar to the findings in the current study by Abdelghani et al The authors conclude that the extent of oversizing has an inverse relationship with subsequent PPM, an observation to be expected with the “larger is better” concept implied by the use of the effective orifice area (EOA) to BSA ratio to define the presence of PPM. However, in this study the mean oversizing of the Sapien 3 valves was only 3.8%, well below the standard of those operators who add volume to increase the percent oversizing to 10% or greater (primarily to prevent paravalvular leak) . The results of the study by Abdelghani et al suggest that in select patients with low predicted EOA/BSA ratios, greater oversizing may reduce PPM—albeit with the risk of annular damage or valve disruption …”

Transcatheter Aortic and Mitral Valve‐in‐Valve Implantation Using the Edwards Sapien 3 Heart Valve

“…For example, overexpansion of the 23‐mm S3 THV, with an extra 2 mL of filling volume, results in a prosthesis diameter of ≈24 mm—mainly at the in‐ and outflow part of the valve frame—while preserving normal valve function 10. This under/overexpansion capability of the S3 means that the size of the implanted THV can be more precisely tailored to the dimensions of the bioprosthesis during VIV procedures, thus avoiding excessive oversizing.…”

“…In borderline cases between 2 S3 THV sizes (oversizing range of 0–1 mm based on T‐ID or CT‐ID), the smaller S3 valve can be safely overexpanded in order to optimize valve leaflet function and ensure anchoring10 (Figure 6). Furthermore, overexpansion by overfilling of the deployment balloon with additional volume results in further flaring, mainly of the in‐ and outflow segments of the S3 valve10; this may also play a role in better fixation of the S3 THV within bioprosthetic surgical valves. During mitral VIV procedures in particular, some degree of flaring of the ventricular portion of the S3 is recommended to avoid late atrial dislodgement 34…”

“…Several new features of the S3 THV, especially its outer skirt and the ability to overexpand its stent frame,10 may have an impact for choosing the optimal size of S3 THV for aortic and mitral VIV implantation.…”

Initial results from the off‐label use of the SAPIEN S3 valve for percutaneous transcatheter pulmonary valve replacement: A multi‐institutional experience

“…Notably, the Sapien S3 valve has a proximal polyethylene terephthalate (PET) lining or “skirt” that is designed to decrease the risk of perivalvular leaks, and the valve itself is longer than its predecessor which is advantageous for stability in TPVR (Figure ) . The S3 valve comes in 20, 23, 26, and 29 mm sizes and can also be over‐dilated to fit a larger diameter landing zone while still maintaining leaflet coaptation …”