Mid-term impact of underfilling and overfilling of the SAPIEN 3 balloon-expandable transcatheter aortic valve implantation on mortality and valve function

Ishizu, Kenichi; Shirai, Shinichi; Tashiro, Hiroaki; Kitano, Kazuki; Tabata, Hiroyuki; Morofuji, Toru; Nakamura, Miho; Murakami, Naoto; Morinaga, Takashi; Hayashi, Masaomi; Isotani, Akihiro; Arai, Yoshinori; Ohno, Nobuhisa; Kakumoto, Shinichi; Ando, Kenji

doi:10.1007/s00380-022-02109-9

Cited by 4 publications

(3 citation statements)

References 23 publications

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“…Moreover, a previous study has shown comparable EOAs at 3 years after TAV implantation between overfilling, nominal, and underfilling groups. 3) Furthermore, implanting small TAV with overfilling resulted in shortening the height of TAV, and, in this case, the risk plane was below the STJ, indicating the minimal risk of sinus sequestration by redoing TAVI in the future.…”

Section: Discussionmentioning

confidence: 74%

How Far Out-of-Range Smaller SAPIEN 3 Ultra RESILIA Valve Implantation with Overfilling Is Acceptable?

Miyahara,

Ishizu,

Shirai

et al. 2024

Journal of Transcatheter Valve Therapies

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With expanding indications for transcatheter aortic valve implantation (TAVI), structural valve degeneration (SVD) of transcatheter aortic valve (TAV) can occur over time.It may eventually require repeat invasive treatment in the future. Redo TAVI is considered a feasible option in such cases; however, the risk of coronary obstruction owing to sinus sequestration caused by the tilted-up first TAV leaflets is a major concern. 1) Therefore, the feasibility of redoing TAVI should be considered during initial TAVI for young patients or patients with a risk for early SVD. Case PresentationA 74-year-old female patient, who was relatively small with a body surface area of 1.32 m 2 , was referred to our Objective: The repeatability of transcatheter aortic valve implantation (TAVI) is an important issue for younger patients or patients with early structural valve deterioration (SVD) concerns. Case Presentation: A 74-year-old female patient on hemodialysis (HD) visited our hospital for symptomatic severe aortic stenosis and difficulty of HD. She was at a high risk for open-heart surgery, and our heart team decided to perform TAVI. Pre-procedural electrocardiogram showed a complete right bundle branch block, and multidetector computed tomography (MDCT) revealed a low height of coronary artery and sinotubular junction and short membrane septum. Because she was on dialysis, we were concerned about early SVD, and implanting a 23-mm SAPIEN 3 Ultra RESILIA, which was suitable for her aortic annulus, would be a high risk for sinus sequestration in the future redo TAVI. Furthermore, she was at high risk for complete atrioventricular block, and implanting a transcatheter aortic valve (TAV) at a low position was not acceptable. So, we decided to select a 20-mm SAPIEN 3 Ultra RESILIA implanting overfilling with 2 ml. TAVI was performed with no complication, and post-procedural echocardiography revealed the TAV function was acceptable, and MDCT after TAVI showed suitable anatomy for redo TAVI. Conclusion:We experienced a successful TAVI case with an out-of-range smaller SAPIEN 3 Ultra RESIRIA. An out-ofrange smaller balloon-expandable valve might be a good choice if TAVI is required to be redone in the future.

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Section: Discussionmentioning

confidence: 74%

How Far Out-of-Range Smaller SAPIEN 3 Ultra RESILIA Valve Implantation with Overfilling Is Acceptable?

Miyahara,

Ishizu,

Shirai

et al. 2024

Journal of Transcatheter Valve Therapies

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“…Third, a larger valve with underfilling was frequently used in BE TAV implantation for border zone annulus in our study population to obtain a larger effective orifice area, as previously shown. 16 , 22 Generally, by adjusting the filling volume of BE TAVs with limited sizes, continuously distributed native annular areas are covered. However, because the BE TAV has the structural property of foreshortening with TAV expansion, a larger valve size with underfilling demonstrated a significantly greater TAV height than a smaller valve size with overfilling, albeit with comparable TAV areas.…”

Section: Discussionmentioning

confidence: 99%

“…Implantation depth of the TAV was expressed as the mean of the distances from the bottom of the coronary cusp to the proximal edge of the stent frame measured at each cusp. 16 With respect to the BE TAV, TAV height was also measured on each cusp by using maximum-intensity projection, 16 and we defined asymmetrical foreshortening of the TAV as (maximum TAV height/minimum TAV height − 1) × 100% of >10% ( Supplemental Figure 2 ). Indeed, asymmetrical foreshortening may affect the degree to which TAV leaflets are tilted up during simulated redo TAVR, but because the effect is likely to be subtle and difficult to predict accurately, in our analysis, all leaflets of asymmetrically foreshortened TAVs were assumed to lift up to the commissure level as in usual cases.…”

Section: Methodsmentioning

confidence: 99%

Assessing Potential Risks of Future Redo Transcatheter Aortic Valve Replacement in Asian Patients

Miyawaki,

Ishizu,

Shirai

et al. 2024

JACC: Asia

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