Wiley
Catheterization and Cardiovascular Interventions
,  volume 105 ,  issue 5 ,  pages 1067-1076

Commissural Alignment in SAPIEN 3 Valves: Impact on Gradient and Mortality at Follow‐Up

Leire Unzue 1, 2
, 
Belén Díaz Antón 2, 3
, 
Adrián Peláez Laderas 2, 4, 5
, 
Lorena Martín Polo 2, 6
, 
Jose María Castellano Vázquez 2, 6
, 
Francisco José Rodríguez Rodrigo 2, 6
, 
Francisco Javier Parra Jimenez 2, 6
, 
Leticia Fernández-Friera 2, 3, 4, 6
, 
Rodrigo Teijeiro Mestre 1, 2
, 
Eulogio García Fernández 1, 2
1
 
Departamento de Cardiología Intervencionista HM CIEC MADRID (Centro Integral de Enfermedades Cardiovasculares), HM Hospitales Madrid Spain | 
2
 
Instituto de Investigación Sanitaria HM Hospitales Madrid Spain | 
3
 
Departamento de imagen cardiaca HM CIEC MADRID (Centro Integral de Enfermedades Cardiovasculares), HM Hospitales Madrid Spain | 
4
 
5
 
6
 
Departamento de Cardiología HM CIEC MADRID (Centro Integral de Enfermedades Cardiovasculares), HM Hospitales Madrid Spain | 
Publication type: Journal Article
Publication date: 2025-01-26
Wiley
scimago Q1
wos Q3
SJR: 1.010
CiteScore: 5.1
Impact factor: 1.9
ISSN: 15221946, 1522726X
Abstract
ABSTRACT
Background

Commissural misalignment (CMA) has demonstrated to difficult future coronary access in self‐expandable prosthesis and has been related with subclinical leaflet thrombosis and a potential increase in valve gradients and aortic regurgitation at follow‐up.

Aims

The aim of our study was to assess the commissural alignment of the balloon expandable SAPIEN 3 valve (Edwards Lifesciences) and to evaluate its impact on transvalvular gradient and mortality at 5 years of follow‐up.

Methods

Consecutive patients treated with SAPIEN 3 prosthesis guided with intraprocedural transesophageal echocardiogram (TEE) with a minimal follow‐up of 5 years were included. Commissural alignment between the prosthesis and the native valve was measured by TEE by two independent cardiologists using a standardized 3‐cusp view pre and post‐valve deployment. CMA was defined as a neocommissure deviation > 30° compared with native commissures. Echocardiographic gradients and clinical events were recorded during follow‐up and compared between groups.

Results

One hundred and five patients (54% male, mean age 80.4 years) were included; 63 (40%) were classified as “aligned” (CMA < 30°) and 42 (60%) as “misaligned” (CMA > 30°). Patients with CMA > 30° presented smaller aortic annulus (23.8 vs. 20.7, p < 0.01) and received smaller valves. There was a slight increase of mean transvalvular gradient during follow‐up (9.2−10.3 mmHg, p < 0.05), without significant differences between groups. Mortality rate was 16.2% at 1 year and 49.5% at 5 years; and not related to commissural alignment.

Conclusions

Significant CMA is present in 40% of patients treated with SAPIEN 3 valves, however, we didn't find a significant association between CMA and gradient increase or mortality during long‐term follow‐up.

Found 
Found 

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Unzue L. et al. Commissural Alignment in SAPIEN 3 Valves: Impact on Gradient and Mortality at Follow‐Up // Catheterization and Cardiovascular Interventions. 2025. Vol. 105. No. 5. pp. 1067-1076.
GOST all authors (up to 50) Copy
Unzue L., Antón B. D., Laderas A. P., Polo L. M., Vázquez J. M. C., Rodrigo F. J. R., Jimenez F. J. P., Fernández-Friera L., Mestre R. T., Fernández E. G. Commissural Alignment in SAPIEN 3 Valves: Impact on Gradient and Mortality at Follow‐Up // Catheterization and Cardiovascular Interventions. 2025. Vol. 105. No. 5. pp. 1067-1076.
RIS |
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RIS Copy
TY - JOUR
DO - 10.1002/ccd.31418
UR - https://onlinelibrary.wiley.com/doi/10.1002/ccd.31418
TI - Commissural Alignment in SAPIEN 3 Valves: Impact on Gradient and Mortality at Follow‐Up
T2 - Catheterization and Cardiovascular Interventions
AU - Unzue, Leire
AU - Antón, Belén Díaz
AU - Laderas, Adrián Peláez
AU - Polo, Lorena Martín
AU - Vázquez, Jose María Castellano
AU - Rodrigo, Francisco José Rodríguez
AU - Jimenez, Francisco Javier Parra
AU - Fernández-Friera, Leticia
AU - Mestre, Rodrigo Teijeiro
AU - Fernández, Eulogio García
PY - 2025
DA - 2025/01/26
PB - Wiley
SP - 1067-1076
IS - 5
VL - 105
SN - 1522-1946
SN - 1522-726X
ER -
BibTex |
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BibTex (up to 50 authors) Copy
@article{2025_Unzue,
author = {Leire Unzue and Belén Díaz Antón and Adrián Peláez Laderas and Lorena Martín Polo and Jose María Castellano Vázquez and Francisco José Rodríguez Rodrigo and Francisco Javier Parra Jimenez and Leticia Fernández-Friera and Rodrigo Teijeiro Mestre and Eulogio García Fernández},
title = {Commissural Alignment in SAPIEN 3 Valves: Impact on Gradient and Mortality at Follow‐Up},
journal = {Catheterization and Cardiovascular Interventions},
year = {2025},
volume = {105},
publisher = {Wiley},
month = {jan},
url = {https://onlinelibrary.wiley.com/doi/10.1002/ccd.31418},
number = {5},
pages = {1067--1076},
doi = {10.1002/ccd.31418}
}
MLA
Cite this
MLA Copy
Unzue, Leire, et al. “Commissural Alignment in SAPIEN 3 Valves: Impact on Gradient and Mortality at Follow‐Up.” Catheterization and Cardiovascular Interventions, vol. 105, no. 5, Jan. 2025, pp. 1067-1076. https://onlinelibrary.wiley.com/doi/10.1002/ccd.31418.