Mechanisms underlying superior outcomes of transcatheter aortic valve implantation with the latest balloon expandable valve

Abstract Transcatheter aortic valve implantation (TAVI) using SAPIEN 3 Ultra RESILIA (S3UR) offers improved hemodynamic performance than its former generation, SAPIEN 3 (S3). This study compared 1-year clinical outcomes after TAVI using S3UR and S3. Among 2,369 patients from the OCEAN-TAVI registry (UMIN000020423), a 1:1 propensity score-matched analysis identified 775 matched pairs. One-year post-TAVI, S3UR showed significantly lower all-cause mortality (10.3% vs. 13.4%, p = 0.026), stroke (0.9% vs. 3.4%, p = 0.001), and heart failure rehospitalization (1.4% vs. 2.7%, p < 0.001) than S3. These differences were pronounced in patients receiving smaller valves (20–23 mm). S3UR demonstrated a larger effective orifice area, lower mean pressure gradient, and lower incidence of paravalvular leakage than S3 at discharge. At 1 year, S3UR showed significantly reduced paravalvular leakage and lower incidences of mean pressure gradient ≥20 mmHg than S3. We concluded that S3UR demonstrated superior hemodynamic performance to S3, exhibiting better prognosis, particularly in patients with smaller valves.