Table 1 : Baseline Characteristics

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Table 1 : Baseline Characteristics Comparison of Acute Elastic Recoil Between the SAPIEN-XT and SAPIEN valves in Transfemoral - Transcatheter Aortic Valve Replacement Cleveland Clinic Aatish Garg MD*; Akhil Parashar MD*; Shikhar Agarwal MD MPH; Olcay Aksoy MD; Kanhaiya Poddar MD; Rishi Puri MD; Lars Svensson MD PhD; Amar Krishnaswamy MD; E Murat Tuzcu MD; Samir R Kapadia MD *Dr.Garg and Dr.Parashar contributed equally to this work Cleveland, Ohio INTRODUCTION RESULTS RESULTS SAPIEN-XT is a newer generation balloon-expandable valve with a stent-structure created of cobalt chromium, as opposed to the stainless steel stent used in the older generation SAPIEN valve that was used in TAVR. We sought to determine if there was difference in acute recoil between the two valves. Table 1 : Baseline Characteristics Table 2: Comparison of recoil in SAPIEN and SAPIEN-XT valves stratified by valve size. Table 3: Valve performance and hemodynamic outcomes stratified by valve type.* Characteristic SAPIEN SAPIEN XT p-value N 41 36 Valve Size 26 mm 20 23 mm 21 16 Mean (SD) age, years 77.2 (11.5) 82.4 (7.6) 0.03 Prior AR >2+ 17 (41.5) 11 (30.6) 0.5 Mean (SD) STS, % 8.9 (6.8) 9.9 (4.7) Mean (SD) Logistic Euro Score 19.6 (17.6) 22.7 (15.7) 0.4 Mean (SD) calcification score 1778 (1733) 1519 (1240) Mean (SD) annulus area, cm2 4.43 (0.61) 4.55 (0.58) Median (IQR) cover index, % 11.3 (-1.6 to 12.4) 3.6 (-0.9 to 8.4) 0.9 Characteristic SAPIEN SAPIEN XT p-value 23 mm Number 21 16 Acute recoil (SD), % 2.77 (1.14) 3.75 (1.52) 0.04 26 mm 20 Acute recoil (SD),% 2.85 (1.4) 4.32 (1.63) 0.01 Characteristic SAPIEN SAPIEN XT Number (N) 41 36 Mean (SD) =SBP, mm Hg 133.9(19.4) 140.5(18.5) Mean (SD) LVEDP, mm Hg 20.2 (7.9) 20.8 (5.2) AR >2+ (%) 9 (21.9) 7 (19.4) Mean (SD) AR index, % 28.7 (9.6) 27.7 (7.3) Mean (SD) Δ mean PA pressure, mm Hg 5.6 (3.9) 5.3 (4.2) Mean (SD) EF, percent 49.4 (16.1) 53.5 11.9) AIM To determine if there is a difference in acute recoil between the two valves types. To assess if there is a relation of this acute recoil to valve performance. Figure 3 : Two way scatter plot demonstrating correlation between Acute Recoil and Aortic Regurgitation Index. METHODS All patients who underwent TF-TAVR using the SAPIEN XT valves at Cleveland Clinic until March 2013 were included. Recoil was measured using biplane cine-angiographic image analysis of valve deployment (Figure1). Acute recoil was defined as [(valve diameter at maximal balloon inflation)- (valve diameter after deflation)] / valve diameter at maximal balloon inflation (reported as percentage). Patients undergoing SAPIEN valve implantation were used as the comparison group. AR index was calculated from the waveform data collected during the procedure. It was defined as (after valve deployment): [ (Diastolic BP- LVEDP) / Systolic BP ]* 100 Figure 4: Multivariable linear regression model demonstrating increased acute recoil in SAPIEN XT valves compared to SAPIEN valves. *All comparisons were statistically non significant. Figure 2 : Comparison of acute recoil (%) between the SAPIEN and SAPIEN-XT valves, stratified by valve size. CONCLUSIONS Figure 1: Cine-angiographic images of valve deployment in the right anterior oblique view The cobalt-chromium SAPIEN XT valve used for TAVR has a greater tendency to recoil acutely after implantation when compared to the stainless-steel SAPIEN valve, irrespective of size of the prosthesis. The difference in acute recoil was not predicted by the cover index or the degree of aortic annular calcification. The SAPIEN XT valve scaffold possesses significantly thinner struts than the SAPIEN valve scaffold, possibly explaining the greater recoil. There is no difference in AR index score or degree of paravalvular leak at 30 days between these valves. Panel A demonstrates the valve at maximum balloon inflation Panel B demonstrates the valve after the balloon has been deflated.