Multicenter evaluation of transcatheter aortic valve replacement using either SAPIEN XT or CoreValve: Degree of device oversizing by computed‐tomography and clinical outcomes

Abstract

Optimal clinical performance of CoreValve and SAPIEN XT appears to be reached with different degrees of oversizing. Certain annular sizes that allow for only moderate or large oversizing, but not both, appear to benefit from a device specific approach.

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

“…It is generally accepted that CV requires a higher degree of oversizing than XT to prevent PVL. 4,16) In our series, the degree of oversizing was comparable between both valves. Furthermore, no significant difference in rates of PVL was found in the excessive oversizing group (> 20% oversizing), following XT versus CV implantations.…”

“…The manufacturer's recommended nominal inflation volume of the deployment balloon for the 23-, 26-, and 29-mm transfemoral Novaflex delivery system (Edwards Lifesciences, Inc.) are 17, 22, and 33 mL, respectively. The nominal inflation volumes for the 23-, 26-, and 29-mm transapical Ascendraþ delivery system (Edwards Lifesciences, Inc.) are 16,20, and 30 mL, respectively. A recently validated 850 Hounsfield unit threshold was used to detect areas of calcium in the region of interest.…”

Transcatheter Aortic Valve Replacement With Different Valve Types in Elliptic Aortic Annuli

“…Severe aortic valve calcification and oversizing were shown to be an independent predictor of PVL after SE-and BE-TAVR in prior studies. 5,7,20 In the present study, use of SE valve for elliptic annuli resulted in lower device success rates, but increased oversizing of SE valves resulted in higher device success rates, whereas the degree of BE valve oversizing had little effect on device success rate (Figure 3). On ROC curve analysis, lower oversizing of SE valves for elliptic annulus predicted unsuccessful device implantation.…”

Minimalist Approach to Evaluating Patients for Transcatheter Aortic Valve Replacement

“…7 It is now well known that cardiac CT is crucial for TAVR sizing and prevention of paravalvular leakage and that each transcatheter device performs optimally within a specific range of oversizing degrees. 8 In addition, cardiac CT occasionally detect adverse root features associated with annular injury or coronary obstruction and can identify important anatomic features such as leaflet fusion (ie, bicuspid aortic valve). CT may also assist in selecting an optimal projection for device implantation.…”