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March 4, 2026npj Cardiovascular Health0 citationsOpen Access

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

JIJuri IwataMYMasanori YamamotoRARyo Arita

Key Result

The SAPIEN 3 Ultra RESILIA valve reduced 1-year all-cause mortality from 13.4% to 10.3% compared to SAPIEN 3 in elderly patients undergoing TAVI, with HR 0.79 (95% CI 0.60–1.04), p=0.089; mortality benefit was significant in patients with smaller valves.

Key Points

  • To compare 1-year clinical outcomes of SAPIEN 3 Ultra RESILIA and SAPIEN 3 after transcatheter aortic valve implantation.
  • Conducted a 1:1 propensity score-matched analysis of patients in the OCEAN-TAVI registry.
  • Compared outcomes between S3UR and S3 for 1 year post-TAVI.
  • Evaluated all-cause mortality, stroke, and heart failure rehospitalization.
  • S3UR showed lower all-cause mortality (10.3% vs. 13.4%) and stroke (0.9% vs. 3.4%) than S3.
  • Heart failure rehospitalization was significantly lower with S3UR (1.4% vs. 2.7%).
  • S3UR demonstrated a larger effective orifice area and a lower mean pressure gradient at discharge.

Study Design

Type

Observational (n=1,550)

Multicenter

Yes

Structured PICO

Does TAVI with the SAPIEN 3 Ultra RESILIA valve improve 1-year clinical outcomes and hemodynamics compared to the SAPIEN 3 valve in patients with aortic stenosis?

P
Population
2,369 patients with aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) from the OCEAN-TAVI registry (775 propensity-matched pairs analyzed), mean age 83.6, 41.3% male, based in Japan.
I
Intervention
Transcatheter aortic valve implantation (TAVI) using the balloon-expandable SAPIEN 3 Ultra RESILIA (S3UR) valve
C
Comparator
Transcatheter aortic valve implantation (TAVI) using the previous generation SAPIEN 3 (S3) valve (historical cohort)
O
Outcome
1-year clinical outcomes including all-cause mortality, stroke, and heart failure rehospitalizationhard clinical

The latest-generation SAPIEN 3 Ultra RESILIA valve demonstrated superior 1-year clinical outcomes and echocardiographic hemodynamics compared to the SAPIEN 3 valve, particularly in patients with smaller aortic annuli.

Main Result

Effect estimate: HR 0.79 (95% CI 0.602–1.036)

Absolute Event Rate: 10.3% vs 13.4%

p-value: p=0.089

Limitations

  • Observational non-randomized design with potential residual confounding despite propensity score matching
  • No independent core laboratory for echocardiographic assessments
  • Data on post-TAVI multidetector CT not available to investigate changes in valve effective orifice area and paravalvular leakage in detail
  • Potential learning curve and temporal bias because S3 was historical cohort and S3UR more recent
  • Unclear whether benefits derive from RESILIA tissue or skirt design improvements
  • Generalizability limited to elderly Japanese population with mean age 83.6 years
  • S3 group was a historical cohort, introducing potential bias from procedural inexperience and different baseline surgical risks
  • Lack of precise data dividing cardiovascular and non-cardiovascular mortality

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 (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.

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Cite This Study

Iwata et al. (2026) conducted an observational in Elderly patients (mean age 83.6 years) with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) with balloon-expandable valves (n=1,550). SAPIEN 3 Ultra RESILIA (S3UR) balloon-expandable transcatheter aortic valve vs. SAPIEN 3 (S3) balloon-expandable transcatheter aortic valve was evaluated on 1-year all-cause mortality (HR 0.79, 95% CI 0.602–1.036, p=0.089). The SAPIEN 3 Ultra RESILIA valve reduced 1-year all-cause mortality from 13.4% to 10.3% compared to SAPIEN 3 in elderly patients undergoing TAVI, with HR 0.79 (95% CI 0.60–1.04), p=0.089; mortality benefit was significant in patients with smaller valves.

synapsesocial.com/papers/69a7cc8ed48f933b5eed821ahttps://doi.org/10.1038/s44325-026-00105-w
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients2016 · 5,096 citations
  2. 2Early results of the Resilia Inspiris aortic valve in the old age patients - a retrospective comparison with the Carpentier Edwards Magna Ease2020 · 25 citations
  3. 3Performance and outcomes of the SAPIEN 3 Ultra RESILIA transcatheter heart valve in the OCEAN-TAVI registry2024 · 52 citations
  4. 4Extremely Small 20-mm Versus Standard-Size Balloon-Expandable Transcatheter Heart Valves2024 · 11 citations
  5. 5Effect of Valve Type and Anesthesia Strategy for TAVR2024 · 30 citations