• Ronald K Binder, John G Webb, Stefan Toggweiler, Melanie Freeman, Marco Barbanti, Alexander B Willson, Donya Alhassan, Cameron J Hague, David A Wood, and Jonathon Leipsic.
• St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
• JACC Cardiovasc Interv. 2013 May 1;6(5):462-8.

ObjectivesThis report sought to study the impact of the balloon-expandable SAPIEN XT (Edwards Lifesciences, Irvine, California) transcatheter heart valve (THV) stent frame geometry and position on outcomes of transcatheter aortic valve replacement (TAVR).BackgroundPost-implant THV geometry and position might impact atrioventricular conduction, hemodynamic performance, and annular sealing.MethodsEighty-nine consecutive patients who underwent TAVR with a Sapien XT THV had pre- and post-implant multidetector computed tomography, transthoracic echocardiography, and electrocardiograms performed to assess THV stent geometry, atrioventricular conduction, and hemodynamic performance.ResultsThe THV Circularity (THV eccentricity <10% [eccentricity = minimum stent diameter/maximum stent diameter]) and under-expansion (THV area/nominal THV area <90%) were present in 97.8% (2 of 89) and 0%, respectively. Low THV implantation was associated with new left bundle branch block and complete heart block (3.4 ± 2.0 mm vs. 5.5 ± 2.9 mm, p = 0.01) and with the need for permanent pacemaker implantation (3.5 ± 2.0 mm vs. 7.1 ± 2.5 mm, p = 0.001). In contrast, labeled THV size and THV area oversizing was not associated with atrioventricular conduction disturbances. The relation between inflow stent frame area and annular area was related to paravalvular regurgitation (p = 0.025). Labeled prosthesis size but not prosthesis expansion or eccentricity was related to valve gradient (p = 0.005) and effective orifice area (p < 0.001).ConclusionsLow implantation depth of balloon-expandable THVs is associated with clinically significant new conduction disturbances and permanent pacemaker implantation. Importantly, annular area oversizing was not associated with these complications.Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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