Jonathon Avrom Leipsic MD, Presenter: Speakers Bureau, General Electric Company Speakers Bureau, Edwards Lifesciences Corporation Consultant, Heartflow, Inc Consultant, Circle Cardiovascular Imaging Inc

Danny Dvir, Abstract Co-Author: Nothing to Disclose

Philipp Blanke MD, Abstract Co-Author: Nothing to Disclose

Nicolo Piazza, Abstract Co-Author: Consultant, Medtronic, Inc

Marco Barbanti, Abstract Co-Author: Nothing to Disclose

John Webb MD, FRCPC, Abstract Co-Author: Consultant, Edwards Lifesciences Corporation

Data on degree of device oversizing associated with optimal clinical outcomes after transcatheter aortic valve replacement (TAVR) is limited.  

A multicenter analyses of consecutive transfemoral TAVR procedures using either SAPIEN XT or CoreValve was utilized. Oversizing zones were defined for SAPIEN XT (5- 20% area oversizing or 2.5-9.5% perimeter oversizing) and for CoreValve (20-35% area oversizing or 9.5-16.2% perimeter oversizing). “favorable-SAPIEN XT” (FXT) zone and “favorable- CoreValve” (FCV) zone included annular sizes for which implantation of either a SAPIEN XT or a CoreValve, respectively, allowed for presumed favorable oversizing.

A total of 368 patients were included in the study: 178 patients in the FCV zone (treated by either CoreValve, n=90 or SAPIEN XT, n=88) and 190 patients in the FXT zone (treated by either SAPIEN XT, n=78, or CoreValve, n=112). In FCV zone, those treated by SAPIEN XT had more annular rupture and conversion to cardiac surgery in comparison with those treated by CoreValve (3.4% vs. 0, p=0.04 and 4.5% vs. 0, p=0.02, respectively). In FXT zone, those treated by CoreValve had more post balloon dilatation and 30-day major stroke in comparison with those treated by SAPIEN XT (16.1% vs. 7.7%, p=0.04 and 8% vs. 1.3%, p=0.02, respectively).

Optimal clinical performance of CoreValve and SAPIEN XT appears to be reached with different degrees of device oversizing. An individualized-device-approach during TAVR, utilizing a specific device for a specific annulus size, enabling favorable degree of oversizing, may improve clinical outcomes. This approach should be further validated in future trials.

An individualized-device-approach during TAVR, utilizing a specific device for a specific annulus size, enabling favorable degree of oversizing, may improve clinical outcomes

Leipsic, J, Dvir, D, Blanke, P, Piazza, N, Barbanti, M, Webb, J, Multicenter Evaluation of Transcatheter Aortic Valve Replacement Using Either SAPIEN XT or CoreValve: Degree of Device Oversizing and Clinical Outcomes.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14007302.html