Do Edwards SAPIEN valves fit to the annulus?

Abstract

Congratulations to the authors for this valuable study [1]. In this paper, it was stated that it was controversial whether the measurements regarding the aortic annulus should be made from the virtual annulus or the coronal hinge-to-hinge while deciding on transcatheter aortic valve implantation (TAVI). As seen in Figure 1d, the prosthetic valve sits on the thick aortic leaflet in TAVI for aortic stenosis. This means that thick leaflets may obstruct the coronary orifices during deployment of the prosthetic valve after opening the valve in order to fit the annulus. Instead of measuring the annulus, one should take into consideration the orifice area, three-dimensional configuration of the aortic leaflets (including leaflet thickness), desired orifice area and from where the orifice area could be gained. The leaflet thickness is an important issue and as seen in Figure 2e, the right side of the valve stent is so close to the aortic wall that it may obstruct the coronary ostium. When five patients with paravalvular leak were investigated, it was found out that Edwards-Sapien valves were inserted in smaller sizes (26, 23, 23, 23 and 23-mm) than the measured virtual ring diameters (28.2, 27.4, 26.9, 25.8 and 26.8 mm). However, no paravalvular leak was observed in patients with maximum virtual ring diameters measured with multislice computed tomography (26.8, 28.5, 28.9, 29 and 27 mm) who received Edwards-Sapien valves of 26-mm. This finding supports our theory. This topic was investigated in the ‘Discussion’ section and it indicates the inappropriateness of the measurement method of calculated average annulus diameter (CAAD). The aortic orifice area increased from 0.7 to 3.6 cm with TAVI. The risk of leaflet rupture is high at the point of least firmness. This has nothing to do with aortic stenosis as seen in Figure 4b. The preand post-TAVI measurements in Table 2 showed no significant differences. Our opinion is that there is no correlation between the TAVI procedure and the measurement methods. We must clarify that the following CAAD measurement is wrong: