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Transfemorally or transapically deployed Sapien Edwards bioprosthesis is always deformed
Bachir Allam1, Rachid Zegdi, Didier Blanchard
1Service de Cardiologie, Université René Descartes, Paris V, AP-HP, Hôpital Européen Georges Pompidou, Paris, France.
Objective:
To study the impact of femoral compared to apical access on the Sapien-Edwards (SE) prosthesis deployment and geometry in patients treated with transcatheter aortic valve implantation (TAVI) for aortic stenosis.
Background:
SE prosthesis deformation exists after its deployment through transfemoral (TF-TAVI) approach. However, no study comparing the deformation between TF-TAVI and transapical (TA-TAVI) approaches has yet been published.
Methods:
Forty consecutive patients received TAVI with the SE prosthesis (TF-TAVI n = 25; TA-TAVI n = 15). A fluoroscopic analysis of the prosthesis was then performed. The stent frame geometry was assessed during deployment in the profile view, and after implantation in the profile and frontal views.
Results:
Expansion kinetics revealed a triphasic stent deployment with both approaches; the aortic extremity being the first to open. After implantation, on the profile view, the stent shape was never rectangular (therefore never cylindrical) in both groups. It had a biconic shape in most of the patients (76% vs. 93.3% for TF-TAVI and TA-TAVI patients, respectively, P = 0.224) with a wider aortic extremity relative to the ventricular one. The frontal view analysis showed that circular deployment of the stent was never achieved. A greater leaflet to stent mismatch was noted in TA-TAVI patients, however, the difference was not statistically significant (12% vs. 33.3%, P = 0.126).
Conclusion:
Fluoroscopically assessed, the geometry of SE prosthesis was never cylindrical after deployment, whatever the access for implantation was. Longitudinal deformation was greater after TF-TAVI whereas leaflet to stent mismatch tended to be more pronounced after TA-TAVI.
