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Partner valves: role of a prospective device selection strategy using ACURATE and SAPIEN 3 as complementary devices
Jonathan M Michel1, Mi Chen1, Neria E Winkler1,2
1Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
Background:
Transcatheter aortic valve implantation (TAVI) outcomes using balloon-expandable valves (BEV) and self-expanding valves (SEV) differ owing to device-specific technical features and anatomical factors.
Objectives:
This study aimed to evaluate prospective TAVI device selection based on anatomic features to optimise outcomes compared with published randomised data using two newer-generation devices.
Methods:
A total of 607 consecutive patients with severe aortic stenosis treated at a single centre from 2020 to 2023 underwent TAVI using a prospective device selection strategy. Heavy and/or asymmetric valve calcification and bicuspid anatomy were preferentially treated with SAPIEN 3/SAPIEN 3 ULTRA BEV, whereas small annulus dimensions and less calcified valves were preferentially treated with ACURATE neo/ACURATE neo2 SEV. In-hospital Valve Academic Research Consortium-3 endpoints and 1-year mortality were evaluated.
Results:
ACURATE was used in 182 (30%) patients and SAPIEN 3 in 425 (70%) patients. The proportion of women was higher in the ACURATE group (65% vs. 31%, p < 0.001), and patients were older (84 vs. 80 years, p < 0.001). Technical success (97% vs. 97%, p > 0.99) and new permanent pacemaker implantation during index hospitalisation (10% vs. 10%, p > 0.99) did not differ between the ACURATE and SAPIEN 3 groups. Intended performance was higher in the ACURATE group than in the SAPIEN 3 group (98% vs. 91%, p = 0.005), with aortic regurgitation ≥moderate (2% vs. <1%, p = 0.32), and mean transvalvular gradient ≥20 mmHg (<1% vs. 4%, p = 0.043). The estimated mortality at 1 year was 14% versus 12% (log-rank p = 0.60) in the ACURATE and SAPIEN 3 groups, respectively.
Conclusions:
A prospective device selection strategy using two complementary TAVI valves resulted in comparable outcomes between the SEV and BEV devices. In-hospital intended performance was higher in the ACURATE group. Despite baseline group differences, there was no difference in 1-year mortality.
