At 5 years, COMMENCE results indicate a favourable safety profile and stable haemodynamic performance of a bioprosthetic valve with RESILIA tissue. Ten-year data in an extended follow-up cohort and the RESILIENCE trial with 11-year follow-up are forthcoming.
Insights from the clinical research investigating INSPIRIS RESILIA and Carpentier-Edwards Magna Ease valves
Francesco Onorati
Prof. Augusto D’Onofrio
MVT Aortic 2022, vol.1
– Not only about hemodynamics, this lecture provides comparisons among three bioprostheses
– Similar clinical outcomes, better hemodynamic results, and shorter ICU stays for rapid deployment valves… but newer bioprosthesis tissue technology may raise the bar even higher
Prof. Michael Borger
MVT Aortic 2022, vol.1
-The “aortic size paradox”: an interesting paradox, indeed
-Length? Diameter? Which should we pay more attention to?
-Be sure to pay attention to genetics, biomarkers, abnormal flow, other risk factors, and more
Prof. Marco Di Eusanio
MVT Aortic 2022, vol.1
Prof. Bart Meuris
MVT Aortic 2022, vol.1
- Shorter hospital stays, less anticoagulation, long-term financial savings? Hear about the data of an expert’s personal experience.
- With advanced anti-calcification treatment, the future of bioprostheses is promising not only for patient outcomes, but even from a financial perspective
Dr. Douglas Johnston
STS annual meeting 202
Prof. D’Onofrio – EACTS 2021
Prof. Kocher – EACTS 2021
Ai L et al. Innovations. 2017; 12: 338–45. DOI: 10.1097/imi.0000000000000407
Aim
To develop a clinically relevant aortic root model, and then compare the haemodynamic function of the EDWARDS INTUITY valve (a rapid deployment valve) with the Carpentier- Edwards PERIMOUNT Magna Ease valve (a conventional bioprosthetic valve), in vitro.
Background Information
Many trials have shown the short-term safety and efficacy of sutureless rapid deployment aortic valves, but direct comparisons of the haemodynamic performance of these new valves with conventional bioprosthetic valves are lacking.
Methods
Model development
Multi-slice computed tomography reconstructions in patients with aortic stenosis were used to generate a 3D printed model of an aortic root.
Effective diameter of the aortic annulus was 21 mm, effective area was 3.38 cm2 and LVOT area was 3.01 cm2.
Valve Deployment
For measurement of haemodynamic parameters (EOA, TPG and LVOT geometry), Magna Ease valves were sutured to the model’s annulus, with and without the use of pledgets, and EDWARDS INTUITY valves were secured by balloon inflation. EDWARDS INTUITY
valves were further tested with frames expanded
to 22, 23, 24 and 25 mm.
Figure 1: EDWARDS INTUITY and Magna Ease valves in the aortic root model and cadaver heart
A: EDWARDS INTUITY valve in the model;
B: Magna Ease valve in the model without pledgets;
C: Magna Ease valve in the model, with pledgets;
D: Outflow view of the aortic root model; E: EDWARDS INTUITY valve in the cadaver heart;
F: Magna Ease valve without pledgets in the cadaver heart.
Reproduced from Ai L et al, 2017. © 2017 Wolters Kluwer Health, Inc. Reproduced with permission LVOT in the rubber gasket aortic root model and in the cadaver heart.
Results
Hemodynamic Performance
The EDWARDS INTUITY valve had both a greater EOA and a lower TPG than the Magna Ease valve, irrespective of pledget use (Figure 1). EOA
and TPG were also significantly different between Magna Ease valves with and without pledgets (all p<0.002 or 0.001).
LVOT Performance
Expanding the EDWARDS INTUITY valve frame diameter from 22 to 25 mm increased the average LVOT area index stepwise from 1.07 to 1.34: this minimally affected EOA or TPG (Table 1).
EDWARDS INTUITY valves resulted in more circular LVOTs than Magna Ease valves, although increasing ellipticity did not impact EOA or TPG.
Average maximum flow velocity was lower across the EDWARDS INTUITY valve than the Magna Ease valve without pledgets (p<0.003), as were maximum turbulent shear stress (p<0.02) and turbulent kinetic
energy (p<0.002).
EDWARDS INTUITY valve (n=4) | Magna Ease valve (n=4) | Magna Ease valve with pledgets (n=4) | |
EOA, cm2 | 1.85 ± 0.06 | 1.56 ± 0.01 | 1.21 ± 0.08 |
Mean gradient, mmHg |
16.8 ± 1.3 | 23.4 ± 0.51 | 1.21 ± 0.08 |
EOA: effective orifice area
Table 1: TPG and EOA of models with an EDWARDS INTUITY valve or a Magna Ease valve (with or without pledgets)
Limitations
- Such a model, isolated from the left ventricle, cannot replicate all physiological mechanical properties.
- Pathological changes and normal physiological variations can affect valve performance in vivo: these were not modelled here.
- The use of saline, rather than blood or a substitute, may have affected simulated valve performance.
Conclusions
- Haemodynamic performance was superior for the EDWARDS INTUITY valve than the Magna Ease valve with increased EOA and reduced mean gradient.
- Pledgets worsened Magna Ease valve performance.
- Maximum velocity, turbulent shear stress and kinetic energy were all lower across the EDWARDS INTUITY valve than the Magna Ease valve.
- Haemodynamic advantages may account for the superior clinical performance of rapid deployment valves over conventional surgical valves
Important safety information:
Use of the EDWARDS INTUITY Elite valve system may be associated with new or worsened conduction disturbances,
which may require a permanent cardiac pacemaker implant (PPI). The rate of PPI for the EDWARDS INTUITY Elite
valve is within the range reported in the literature for various rapid deployment valves, but higher than that reported
for surgical aortic valves. Physicians should assess the benefits and risks of the EDWARDS INTUITY Elite valve prior to
implantation. See instructions for use for additional information.
For professional use. For a listing of indications, contraindications, precautions, warnings, and potential adverse events, please refer to the Instructions for Use (consult eifu.edwards.com where applicable).
Edwards devices placed on the European market meeting the essential requirements referred to in Article 3 of the Medical Device Directive 93/42/EEC bear the CE marking of conformity
Edwards, Edwards Lifesciences, the stylized E logo, Carpentier-Edwards, Carpentier-Edwards PERIMOUNT, EDWARDS INTUITY, EDWARDS INTUITY Elite, Magna, Magna Ease, PERI, PERIMOUNT and PERIMOUNT Magna are trademarks are trademarks or service marks of Edwards Lifesciences Corporation or its affiliates. All other trademarks are the property of their respective owners.
© 2021 Edwards Lifesciences Corporation. All rights reserved. PP–EU-2350 v1.0
Edwards Lifesciences • Route de l’Etraz 70, 1260 Nyon, Switzerland • edwards.com
Leon, Martin B., et al., Journal of the American College of Cardiology (2021) DOI:10.1016/j.jacc.2020.12.052
Aim
Report 2-year findings from PARTNER 3, emphasizing the clinical outcomes from 1 to 2 years and using new standardized definitions of hemodynamic valve deterioration and bioprosthetic valve failure
Methods
- 1000 patients randomly assigned (1:1) to transfemoral TAVR with SAPIEN 3 vs. SAVR
- Mean STS score: 1.9%; mean age: 73 years
- Primary endpoint: composite of death from any cause, all stroke or cardiovascular rehospitalization at 1 year
Results
- Overall, complete primary endpoint follow-up through 2 years of 96.5% (TAVR 99%, SAVR 93.8%)
- Functional status, as measured with KCCQ-OS, remained superior for TAVR at 2 years
- Mean gradients were slightly higher after TAVR vs. SAVR (13.6 vs. 11.8 mmHg, p = 0.06; n = 495 and 453 for TAVR and SAVR, respectively) Bioprosthetic valve durability determined using VARC 3 criteria was similar for the 2 groups
Conclusions
- The 2-year follow-up from the PARTNER 3 low-risk trial showed continued superiority of the primary endpoint favoring TAVR versus surgery, but more frequent deaths, strokes, and valve thrombosis events in the TAVR group between 1 and 2 years
- Disease-specific health status at 2 years was better after TAVR than surgery
- Echocardiographic findings through 2 years indicated stable valve hemodynamics and no differences in valve durability parameters
Key talking points
Is there a trend for similar outcomes after TAVR and surgery?
Primary endpoint remained significantly lower with TAVR vs. SAVR, yet the differences in death and stroke have greatly diminished at 2 years. It must be noted that 3 of the 7 deaths occurring between 1- and 2-year follow-up in the TAVR arm were of noncardiac origin (cancer, suicide and sepsis), and 3 of the 6 strokes were disabling. This more granular data points to similar rates of event between year 1 and2 for TAVR and SAVR.
Why was valve thrombosis higher in TAVR patients?
75% of the patients with clinical events committee-adjudicated valve thrombosis were asymptomatic. A computed tomography substudy is running in parallel with the PARTNER 3 trial, increasing awareness on hemodynamic changes and inflating the frequency of valve thrombosis events. The consequences at long term remain uncertain.
Is TAVR the treatment of choice in low-risk patients?
Results of the PARTNER 3 trial are not applicable to all patients at low surgical risk. Exclusion criteria such as bicuspid aortic valves, severe coronary artery disease, concomitant valve disease or vascular disease precluding transfemoral access limit application of these results in these cohorts. Longer follow-up is also needed to assess valve’s durability in younger patients with severe AS.
For professional use. For a listing of indications, contraindications, precautions, warnings, and potential adverse events, please refer to the Instructions for Use (consult eifu.edwards.com where applicable).
Edwards devices placed on the European market meeting the essential requirements referred to in Article 3 of the Medical Device Directive 93/42/EEC bear the CE marking of conformity
Edwards, Edwards Lifesciences, the stylized E logo, PARTNER, PARTNER 3, SAPIEN and SAPIEN 3 are trademarks or service marks of Edwards Lifesciences Corporation or its affiliates. All other trademarks are the property of their respective owners.
© 2021 Edwards Lifesciences Corporation. All rights reserved.
PP–EU-1734 V1.0
Edwards Lifesciences • Route de l’Etraz 70, 1260 Nyon, Switzerland • edwards.com
MVT Fundamentals Course
Dr. Paolo Berretta, Italy
Keywords: aortic stenosis; aortic valve replacement; transvalvular pressure gradients; valve haemodynamics
Rapid deployment valves requiring minimal sutures are an alternative to conventional surgical valves. In addition to facilitating minimally invasive surgery, rapid deployment valves are associated with improved haemodynamic outcomes compared with conventional surgical valves. The mechanism behind these haemodynamic outcomes is unknown.
Sadri et al. present the first in-vitro study that compares a conventional valve with a rapid deployment valve in the same surrounding physiology. PERIMOUNT Magna Ease and EDWARDS INTUITY Elite valves were sequentially implanted in a donor heart, and μ-computerised tomography used to develop 3D-printed flow models for each valve. Sadri et al. explain how the EDWARDS INTUITY Elite, a rapid deployment valve, may increase effective orifice area and lower transvalvular pressure gradients, peak velocities and patient─prosthesis mismatch.
Click on the link below to see how two different valves perform in the same heart.
Click here to access the full publication
Important safety information:
Use of the EDWARDS INTUITY Elite valve system may be associated with new or worsened conduction disturbances, which may require a permanent cardiac pacemaker implant (PPI). The rate of PPI for the EDWARDS INTUITY Elite valve is within the range reported in the literature for various rapid deployment valves, but higher than that reported for surgical aortic valves. Physicians should assess the benefits and risks of the EDWARDS INTUITY Elite valve prior to implantation. See instructions for use for additional information.
For professional use. For a listing of indications, contraindications, precautions, warnings, and potential adverse events, please refer to the Instructions for Use (consult eifu.edwards.com where applicable).
Edwards devices placed on the European market meeting the essential requirements referred to in Article 3 of the Medical Device Directive 93/42/EEC bear the CE marking of conformity.
Edwards, Edwards Lifesciences, the stylized E logo, Carpentier-Edwards, EDWARDS INTUITY, EDWARDS INTUITY Elite, Magna, Magna Ease, PERI, PERIMOUNT, and PERIMOUNT Magna Ease are trademarks or service marks of Edwards Lifesciences Corporation or its affiliates. All other trademarks are the property of their respective owners.
© 2020 Edwards Lifesciences Corporation. All rights reserved.
Edwards Lifesciences • Route de l’Etraz 70, 1260 Nyon, Switzerland • edwards.com
Keywords: aortic stenosis; aortic valve replacement; patient–prosthesis mismatch; rapid-deployment aortic valves
Severe aortic stenosis in low- and intermediate-risk patients is currently treated by surgical aortic valve replacement (SAVR). However, SAVR can cause patient–prosthesis mismatch (PPM), a condition where a patient’s body surface area is too big compared with the effective orifice area of the implant. This mismatch results in higher transvalvular pressure gradients and is associated with a higher risk of adverse outcomes. There is a potential risk of PPM in patients who undergo SAVR due to higher transvalvular pressure gradients, especially if they have a small aortic root.
Coti et al. studied patients with a small aortic root who underwent SAVR with the EDWARDS INTUITY valve. This single-centre cohort analysis provides useful insights by analysing haemodynamic parameters, survival rates, functional class improvements and PPM incidence.
Click on the link below to see the outcomes of the EDWARDS INTUITY valve transplant in at-risk patients.
Click here to access the full publication
Important safety information:
Use of the EDWARDS INTUITY Elite valve system may be associated with new or worsened conduction disturbances, which may require a permanent cardiac pacemaker implant (PPI). The rate of PPI for the EDWARDS INTUITY Elite valve is within the range reported in the literature for various rapid deployment valves, but higher than that reported for surgical aortic valves. Physicians should assess the benefits and risks of the EDWARDS INTUITY Elite valve prior to implantation. See instructions for use for additional information.
For professional use. For a listing of indications, contraindications, precautions, warnings, and potential adverse events, please refer to the Instructions for Use (consult eifu.edwards.com where applicable).
Edwards devices placed on the European market meeting the essential requirements referred to in Article 3 of the Medical Device Directive 93/42/EEC bear the CE marking of conformity.
Edwards, Edwards Lifesciences, the stylized E logo, Carpentier-Edwards, EDWARDS INTUITY, and EDWARDS INTUITY Elite are trademarks or service marks of Edwards Lifesciences Corporation or its affiliates. All other trademarks are the property of their respective owners.
© 2020 Edwards Lifesciences Corporation. All rights reserved.
Edwards Lifesciences • Route de l’Etraz 70, 1260 Nyon, Switzerland • edwards.com
Keywords: aortic bioprostheses; aortic stenosis; aortic valve replacement
Surgical aortic valve replacement (SAVR) is still offered to elderly populations despite the potential for structural valve degeneration. Currently, however, there is limited comparative data on the long-term durability of different SAVR prostheses.
Reporting outcomes including repeat aortic valve replacement, prosthetic valve endocarditis and late all-cause mortality, Biancari et al. present key results from a retrospective, non-randomised, propensity-matched comparative analysis of the Trifecta and Carpentier-Edwards PERIMOUNT Magna Ease valves. The authors compared the outcomes of 2,216 patients who had undergone the procedure to implant one of the two SAVR prostheses.
Click the link below for an update on the latest research in aortic valve replacement.
Click here to access the full publication
For professional use. For a listing of indications, contraindications, precautions, warnings, and potential adverse events, please refer to the Instructions for Use (consult eifu.edwards.com where applicable).
Edwards devices placed on the European market meeting the essential requirements referred to in Article 3 of the Medical Device Directive 93/42/EEC bear the CE marking of conformity.
Edwards, Edwards Lifesciences, the stylized E logo, Carpentier-Edwards, Magna, Magna Ease, PERI, PERIMOUNT and PERIMOUNT Magna are trademarks of Edwards Lifesciences Corporation or its affiliates. All other trademarks or service marks are the property of their respective owners.