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Improved hemodynamic performance and reduced paravalvular regurgitation with the SAPIEN 3 Ultra RESILIA valve: a

Meha Krishnareddigari¹, Golsa Joodi², Radoslav I Zinoviev¹

¹David Geffen School of Medicine, University of California, Los Angeles, CA, United States.

Frontiers in Cardiovascular Medicine

|June 8, 2026

Abstract

Background:

Transcatheter aortic valve replacement (TAVR) has rapidly evolved into a standardized treatment for severe aortic stenosis, particularly in patients at increased surgical risk. The fifth-generation SAPIEN 3 Ultra RESILIA (S3UR) valve notably incorporates RESILIA-treated tissue as well as an enhanced external skirt in order to reduce structural valve deterioration (SVD) and paravalvular leak (PVL). However, real-world data on its clinical performance remains limited.

Objectives:

To evaluate procedural, hemodynamic, and short-term clinical outcomes of the S3UR valve compared to earlier-generation SAPIEN 3 (S3) and SAPIEN 3 Ultra (S3U) platforms in Ronald Raegan UCLA medical center.

Methods:

513 patients who underwent transfemoral TAVR at Ronald Reagan UCLA Medical Center between 2022 and 2024 were analyzed. Of these, 216 received the S3UR valve and 297 received S3U/S3 valves. Propensity-score matching (1:1) yielded 181 well-balanced patient pairs. Primary endpoints included device success per VARC-3 criteria, with secondary endpoints encompassing 30-day safety, echocardiographic performance, and procedural complications.

Results:

The S3UR group demonstrated significantly lower post-procedural and 30-day mean aortic valve gradients (7.45 ± 3.37 mmHg and 9.06 ± 2.94 mmHg, respectively; p < 0.001) compared to the S3U/S3 group. Rates of moderate PVL were 0% in the S3UR group vs. 8.9-10.1% in S3U/S3 patients (p < 0.001). Procedural success exceeded 98% in both groups, with no significant differences in stroke, mortality, or new pacemaker implantation. Readmission rates trended lower in the S3UR cohort (7.8% vs. 13.9%), though not statistically significant.

Conclusions:

The SAPIEN 3 Ultra RESILIA valve demonstrated superior hemodynamic performance and significantly reduced PVL compared to earlier-generation balloon-expandable valves, while maintaining comparable safety and procedural success. These findings add institutional-level evidence to the growing body of data supporting the S3UR valve; however, multicenter prospective studies with longer follow-up are needed to confirm these results and assess long-term durability.

Keywords:

SAPIEN 3 SAPIEN 3 Ultra TAVR - outcomes and related issues TAVR - transcatheter aortic valve replacement aortic valve surgical outcome

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