I came across this article after researching our latest VIV Doctor from St Paul's Hospital in Vancouver. You can see why Janarthanan Sathananthan has elected to choose our DurAVR after he and others did some valve in valve bench tests with the SAPIEN XY & SAPIEN3.



The article is pasted below

Redo-TAVI with SAPIEN 3 in SAPIEN XT or SAPIEN 3 – impact of pre- and post-dilatation on final THV expansion

DOI: 10.4244/EIJ-D-23-00308

David Meier^1,2,3; Uri Landes^4,5; Lars Sondergaard⁶; Ole De Backer⁷; Georg Lutter^8,9; Thomas Puehler^8,9; Mariama Akodad¹⁰; Georgios Tzimas³; Philipp Blanke³; Geoffrey W. Payne¹¹; Althea Lai²; Hacina Gill²; David A. Wood^1,3; John G. Webb^1,3; Stephanie L. Sellers^1,2,3; Janarthanan Sathananthan^1,2,3

1. Centre for Cardiovascular Innovation, St Paul’s Hospital, Vancouver, BC, Canada and Vancouver General Hospital, Vancouver, BC, Canada; 2. Cardiovascular Translational Laboratory, Vancouver, BC, Canada and Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada; 3. Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada; 4. Edith Wolfson Medical Center, Holon, Israel; 5. Rabin Medical Center, Petah Tikva, Israel and Tel Aviv University, Tel Aviv, Israel; 6. Abbott Structural Heart, Santa Clara, CA, USA; 7. Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; 8. DZHK (German Centre for Cardiovascular Research), partner site Kiel/Hamburg/Lübeck, Kiel Germany; 9. Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holsten, Campus Kiel, Kiel, Germany; 10. Institut Cardiovasculaire Paris Sud (ICPS), Hôpital privé Jacques Cartier, Ramsay Santé, Massy, France; 11. University of Northern British Columbia, Prince George, BC, Canada

Background: When a balloon-expandable transcatheter heart valve (THV) is chosen to treat a failed balloon-expandable THV, there is a risk of underexpansion with a potential impact on performance.

Aims: We aimed to assess the impact of pre- and post-dilatation on the expansion of balloon-expandable THVs after redo-transcatheter aortic valve implantation (TAVI).

Methods: Redo-TAVI was performed on the bench with a 23 mm SAPIEN 3 (S3) implanted within a 23 mm SAPIEN XT (SXT) or a 23 mm S3, both of which served as the “failed” THVs. Pre- and/or post-dilatation was performed using a 23 mm non-compliant TRUE balloon. Expansion of the index and redo-THVs were assessed before and after pre-/post-dilatation using microcomputed tomography (micro-CT), and THV hydrodynamic testing was conducted.

Results: Without pre- or post-dilatation, the S3 was underexpanded, for all combinations, particularly in the mid-portion of the THV (18.6 mm and 19.7 mm representing 81% and 86% of the nominal diameter inside the SXT and S3, respectively). Pre- and post-dilatation had an additive effect on diameter expansion of the redo-THV, which remained constrained in most combinations. The only combination to achieve nominal expansion was the S3 in S3 when both pre- and post-dilatation were performed. The S3 remained underexpanded inside the SXT despite pre- and post-dilatation (93% in the mid-portion). Improved redo-THV expansion was accompanied by 2.7 mm (12%) overexpansion of the index THV. While all samples had acceptable hydrodynamic performance, the underexpanded samples had worse leaflet pinwheeling.

Conclusions: When performing redo-TAVI with a 23 mm S3 inside a 23 mm SXT or S3, only the S3 in S3 with the use of pre- and post-dilatation reached full expansion. This underlines the importance of CT assessment of THV expansion and the role of pre-/post-dilatation.