Abstract 13606: Platelet Activation is Less Enhanced in the New Balloon Expandable Edwards Sapien 3 Valve Compared to Its Predecessor Model (Edwards Sapien XT)

Abstract

Aim of the study: Stroke and thromboembolic events after transfemoral aortic valve replacement (TAVR) continue to be a problem. The aim of our study was to compare platelet aggregation (Agg) and platelet activation (PA) observed with two different catheter valves, the ESV-XT and the newer ESV-3 valve in patients (pts) undergoing TAVR on dual antiplatelet therapy (DAPT). Methods and results: 174 pts with severe aortic stenosis and high surgical risk underwent successfully TAVR (60 ESV-XT; 114 ESV-3). Platelet Agg and PA (CD62P expression) were evaluated before and for the following 3 days after TAVR under DAPT. Platelet Agg was inhibited to the same extent in both valve types and there was no significant difference in platelet drop between both valve types between day 0 and day 3 [ESV-XT versus ESV-3: median (25th-75th percentile): platelet count (x 1000 ): 55 (42-74) versus 61(42-93), p=0.280]. However there was an enhanced CD62P expression directly after TAVR with the ESV-XT compared to the ESV-3 [CD62P (MIF): 7.4 (6.8-8.6) versus 6.6 (6-7.9), p=0.014 ]. Surface expression of platelet CD62P was associated with the occurrence of residual aortic regurgitation (AR) and was significantly higher in pts with residual AR [ CD62P (Mild AR) versus CD 62 P (no or trace AR): 7.9 (7.3-9.1) versus 7.1 (6.4 -8.0), p < 0.001)]. Conclusion: Although platelet inhibition was similar in both valve types, platelet activation was significantly enhanced in pts with the ESV-XT compared to the ESV-3 valve and was associated to the amount of residual AR which was significantly reduced by ESV-3, which may have implications for thromboischemic events following TAVR procedure.