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Transcatheter aortic valve implantation in patients with small aortic annuli using a 20 mm balloon-expanding valve
  1. Rishi Puri1,
  2. Jonathan Byrne2,
  3. Ralf Muller3,
  4. Hardy Baumbach4,
  5. Helene Eltchaninoff5,
  6. Simon Redwood6,
  7. Asim Cheema7,
  8. Christophe Dubois8,
  9. Leo Ihlberg9,
  10. Harindra C Wijeysundera10,
  11. Alfredo Cerillo11,
  12. Matthias Götberg12,
  13. Kaj Erik Klaaborg13,
  14. Marc Pelletier14,
  15. Roberto Blanco-Mata15,
  16. Richard Edwards16,
  17. Caterina Gandolfo17,
  18. Douglas Muir18,
  19. Francesco Meucci19,
  20. Jan-Malte Sinning20,
  21. Pieter Stella21,
  22. Verena Veulemans22,
  23. Marko Virtanen23,
  24. Ander Regueiro1,
  25. Martin Thoenes24,25,
  26. Philippe Pibarot1,
  27. Emilie Pelletier-Beaumont1,
  28. Josep Rodés-Cabau1
  1. 1Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
  2. 2King's College Hospital, London, UK
  3. 3Helios Klinikum Siegburg, Siegburg, Germany
  4. 4Robert-Bosch-Krankenhaus, Stuttgart, Germany
  5. 5Hôpital Charles-Nicolle, Rouen, France
  6. 6St. Thomas’ Hospital, London, UK
  7. 7St. Michael's Hospital, Toronto, Ontario, Canada
  8. 8Universitaire Ziekenhuizen and Katholieke Universiteit Leuven, Leuven, Belgium
  9. 9Helsinki University Hospital, Helsinki, Finland
  10. 10Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  11. 11G. Pasquinucci Hospital, Massa, Italy
  12. 12Skane University Hospital, Lund, Sweden
  13. 13Aarhus University Hospital, Aarhus, Denmark
  14. 14New Brunswick Heart Centre, Saint John, New Brunswick, Canada
  15. 15Hospital Universitario de Cruces, Baracaldo, Spain
  16. 16Freeman Hospital, Newcastle Upon Tyne, UK
  17. 17ARNAS Ospedale Civico, Palermo, Italy
  18. 18The James Cook University Hospital, Middlesbrough, UK
  19. 19Azienda Ospedaliero Universitaria Careggi Largo Brambilla, Florence, Italy
  20. 20University Hospital Bonn, Bonn, Germany
  21. 21University Medical Center Utrecht, Utrecht, The Netherlands
  22. 22University Hospital Dusseldorf, Dusseldorf, Germany
  23. 23Tampere University Hospital, Tampere, Finland
  24. 24Edwards LifeSciences, Nyon, Switzerland
  25. 25Léman Research Institute, Switzerland
  1. Correspondence to Dr Josep Rodés-Cabau, Quebec Heart & Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Quebec, Canada G1V 4G5; josep.rodes{at}


Background While transcatheter aortic valve implantation (TAVI) is established for treating high-operative risk surgical aortic valve replacement candidates, until recently the smallest transcatheter heart valve (THV) measured 23 mm, posing greater risk for annular rupture and THV failure in patients with aortic stenosis (AS) with small aortic annuli (≤20 mm).

Objectives In the setting of a multicentre registry, we report on the safety, efficacy and early clinical outcomes of the SAPIEN XT 20 mm balloon-expanding THV.

Results Among TAVI 55 recipients (n=30 for native AS, n=25 for a valve-in-valve procedure (V-in-V)), median age and Society of Thoracic Surgeons score were 85 (81 to 87) years and 7.8 (4.7 to 12.4)%, respectively. Mean and minimum annular diameters were 19±1 and 17±2 mm, respectively, in native patients with AS, and 17±1 mm (internal diameter) in V-in-V recipients. Successful device implantation rate was 96%, with no procedural-related death. Overall in-hospital-30-day death, stroke and major bleeding rates were 5%, 2% and 9%, respectively. In native AS TAVI recipients, mean transaortic gradient decreased from 54±20 to 12±5 mm Hg (p<0.001), and from 45±17 to 24±8 mm Hg (p<0.001) in V-in-V recipients. Severe prosthesis-patient mismatch (PPM) rates were 10% and 48% in native AS and V-in-V TAVI recipients, respectively (p=0.03). Post-TAVI, the rate of moderate aortic regurgitation was 7% and 0% in native AS and V-in-V TAVI recipients, respectively.

Conclusions TAVI with the 20 mm SAPIEN XT THV appears safe and technically feasible, with acceptable short-term clinical outcomes and low rates of severe PPM in those with native AS.

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  • Contributors RP planned the study, collected all data, wrote the manuscript. JB, RM, HB, HE, SR, AC, CD, LI, HCW, AC, MG, KEK, MP, RB-M, RE, CG, DM, FM, J-MS, PS, VV and MV contributed patient data and performed these procedures, provided critical manuscript review. AR contributed patient data, performed these procedures and provided critical manuscript review. MT provided critical manuscript review. PP helped planned the study and provided critical manuscript review. EP-B collected data, performed statistical analysis, drafted manuscript and provided critical review, drafted figures. JR-C contributed patient data, planned the study and provided critical manuscript review.

  • Competing interests HE: proctor for Edwards Lifesciences. SR: travel support and lecture honoraria from Edwards Lifesciences. CD: Proctor for Edwards Lifesciences. LI: consultant for Edwards Lifesciences. HCW: research funding from Edwards Lifesciences. MP: consultant for Edwards Lifesciences. DM: advisory board member and proctor for Edwards Lifesciences. PS: proctor for Edwards Lifesciences. MV: travel expenses from Edwards Lifesciences. MT: employee of Edwards Lifesciences. PP: research support from Edwards Lifesciences for echocardiographic core laboratory analysis of THVs. JR-C: research grant support, and proctoring for Edwards Lifesciences.

  • Ethics approval The study protocol was performed in accordance with the institutional ethics committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.