Comparison between the SAPIEN S3 and the SAPIEN XT transcatheter heart valves:A single-center experience

AIM To investigate the clinical outcomes of transcatheter aortic valve implantation(TAVI) with the SAPIEN 3 transcatheter heart valve(S3-THV) vs the SAPIEN XT valve(XT-THV).METHODS We retrospectively analyzed 507 patients that underwent TAVI with the XT-THV and 283 patients that received the S3-THV at our institution between March 2010 and December 2015.RESULTS Thirty-day mortality(3.5% vs 8.7%:OR=0.44,P=0.21) and 1-year mortality(25.7% vs 20.1%,P=0.55) were similar in the S3-THV and the XT-THV groups.The rates of both major vascular complication and paravalvular regurgitation(PVR)>1 were almost 4 times lower in the S3-THV group than the XT-THV group(major vascular complication: 2.8% vs 9.9%,P<0.0001:PVR>1: 2.4% vs 9.7%,P<0.0001).However,the rate of new pacemaker implantation was almost twice as high in the S3-THV group(17.3% vs 9.8%,P=0.03).In the S3 group,independent predictors of new permanent pacemaker were pre-procedural RBBB(OR=4.9:P=0.001),pre-procedural PR duration(OR=1.14,P=0.05) and device lack of coaxiality(OR=1.13:P=0.05) during deployment.CONCLUSION The S3-THV is associated to lower rates of major vascular complications and PVR but higher rates of new pacemaker compared to the XT-THV.Sub-optimal visualization of the S3-THV in relation to the aortic valvular complex during deployment is a predictor of new permanent pacemaker.