September 5, 2025Open Access

Mechanisms Underlying Superior Clinical Outcomes of Transcatheter Aortic Valve Implantation with the Latest Balloon-Expandable Valve

Key Points

S3UR reduced all-cause mortality to 10.3%, compared to 13.4% for S3, demonstrating better survival rates.
Stroke incidence was significantly lower at 0.9% for S3UR versus 3.4% for S3, indicating a notable improvement in safety.
Patients with S3UR experienced lower heart failure rehospitalization, with rates of 1.4% compared to 2.7% for S3.
The enhanced hemodynamic performance of S3UR suggests it may be particularly beneficial for patients needing smaller valves.

Abstract

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, 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.

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