Objective: To study the impact of femoral compared to apical access on the Sapien-Edwards (SE) prosthesis deployment and geometry in patients treated with transcatheter aortic valve implantation (TAVI) for aortic stenosis.
Background: SE prosthesis deformation exists after its deployment through transfemoral (TF-TAVI) approach. However, no study comparing the deformation between TF-TAVI and transapical (TA-TAVI) approaches has yet been published.
Methods: Forty consecutive patients received TAVI with the SE prosthesis (TF-TAVI n = 25; TA-TAVI n = 15). A fluoroscopic analysis of the prosthesis was then performed. The stent frame geometry was assessed during deployment in the profile view, and after implantation in the profile and frontal views.
Results: Expansion kinetics revealed a triphasic stent deployment with both approaches; the aortic extremity being the first to open. After implantation, on the profile view, the stent shape was never rectangular (therefore never cylindrical) in both groups. It had a biconic shape in most of the patients (76% vs. 93.3% for TF-TAVI and TA-TAVI patients, respectively, P = 0.224) with a wider aortic extremity relative to the ventricular one. The frontal view analysis showed that circular deployment of the stent was never achieved. A greater leaflet to stent mismatch was noted in TA-TAVI patients, however, the difference was not statistically significant (12% vs. 33.3%, P = 0.126).
Conclusion: Fluoroscopically assessed, the geometry of SE prosthesis was never cylindrical after deployment, whatever the access for implantation was. Longitudinal deformation was greater after TF-TAVI whereas leaflet to stent mismatch tended to be more pronounced after TA-TAVI.
©2011, Wiley Periodicals, Inc.