Fluoroscopic "Lucent Line" Visualization in SAPIEN 3 TAVR Deployment: Reproducibility and Impacts on Outcomes

Fluoroscopic radiolucent (lucent) line (LL) visualization in SAPIEN 3 (S3) transcatheter aortic valve replacement (TAVR) has been advocated to optimize implant depth, but reproducibility and outcomes remain unknown. Our goal was to determine the incidence of LL seen at conventional deployment view during S3 TAVR and associated outcomes.

From April 2017 to September 2022, fluoroscopic images of 1130 consecutive transfemoral S3 TAVR were retrospective analyzed. LL visualization at the time of S3 positioning (+ or -) and coaxiality (coaxial [C] or noncoaxial [NC]) of the S3 valve at final implantation in the 3-cusp coplanar view were respectively evaluated. Procedural and in-hospital outcomes per Valve Academic Research Consortium 3 definitions were determined.

LL was present in only 64.8%, and coaxial implant was achieved in only 45.6% of the cases. Three main scenarios were identified: (1) LL(+)/C implant in 44.5%, (2) LL(+)/NC implant in 20.3%, and (3) LL(-)/NC implant in 34.2%. LL deployment resulted in a deeper S3 implantation (LL[+]/C: 19.8% ± 11.0% ventricular vs LL[+]/NC: 18.5% ± 9.7% vs LL[-]/NC: 17.5% ± 12.1%, at noncoronary cusp; P = .008; LL[+]/C 16.3 ± 11.5% vs LL[+]/NC: 15.6% ± 11.1% vs LL[-]/NC: 13.9% ± 13.5% at left-coronary cusp; P = .02). When comparing the 3 scenarios of S3 deployment, there were no differences in outcomes including paravalvular leak, pacemaker implantation, and hemodynamic performance.

LL visualization in S3 TAVR could not be obtained in a significant portion of cases, did not result in a coaxial valve deployment in a majority of cases, and did not achieve a higher valve implantation. However, no short-term clinical and echocardiographic impact was observed.