Transcatheter Aortic Valve Implantation In Patients With a Large Aortic Annulus

Background As the indications for transcatheter aortic valve implantation (TAVI) have expanded, so to have the demands on interventionists to allow as many patients to access this technology as possible. Methods We retrospectively reviewed our TAVI database for patients who had received a 29 mm SAPIEN 3 valve despite having an annular area greater than the manufacturer-recommended upper limit of 683 mm 2, as determined by multi-detector computed tomography (MDCT). Procedural and inpatient outcome data were collected. Results The study population was 5 of 121 patients receiving a SAPIEN 3 valve since it became available in March 2015. Their annular area ranged from 691 to 800 mm(2). Valve deployment was successful in all patients. The deployment balloon volume was nominal, except for an additional 1 ml in one patient. No patient had a new indication for permanent pacing, and no significant valvular or paravalvular regurgitation (PVR) was identified on post-procedure transthoracic echocardiography. All patients survived to hospital discharge. Conclusions In this select group of patients we have demonstrated that it is safe and feasible to use the 29 mm SAPIEN 3 in patients with annular dimensions greater than those recommended, with minimal balloon overfilling.