10-Year Impact of Transcatheter Aortic Valve Replacement Leaflet Design (Intra- Versus Supra-Annular) in Mortality and Hemodynamic Performance

Andrea Scotti, Luca Nai Fovino, Augustin Coisne, Tommaso Fabris, Francesco Cardaioli, Mauro Massussi, Giulio Rodinò, Alberto Barolo, Mauro Boiago, Saverio Continisio, Carolina Montonati, Tommaso Sciarretta, Vittorio Zuccarelli, Valentina Bernardini, Giulia Masiero, Massimo Napodano, Chiara Fraccaro, Alfredo Marchese, Giovanni Esposito, Juan F. GranadaAzeem Latib, Sabino Iliceto, Giuseppe Tarantini

Research output: Contribution to journalArticlepeer-review


Background: The impact of transcatheter aortic valve replacement (TAVR) leaflet design on long-term device performance is still unknown. This study sought to compare the clinical and hemodynamic outcomes of intra- (IA) versus supra-annular (SA) TAVR designs up-to 10-years following implantation. Methods: Consecutive patients with at least 5-years follow-up following TAVR for severe symptomatic aortic stenosis from June 2007 to December 2016 were included. Bioprosthetic valve failure (BVF) and hemodynamic valve deterioration (HVD) were defined according to VARC-3 updated definitions and estimated using cumulative incidence function to account for the competing risk of death. Results: A total of 604 patients (82 years; 53% female) were analyzed and divided into IA (482) and SA (122) groups. Overall survival rates at 10-years were similar (IA 15%, 95%CI: 10–22; SA 11%, 95%CI: 6–20; p = 0.21). Compared to the SA TAVR, mean transaortic gradients were significantly higher and increased over time in the IA group. IA TAVRs showed higher 10-year cumulative incidences of BVF (IA 8% vs. SA 1%, p = 0.02) and severe HVD (IA 5% vs. SA 1%, p = 0.05). The occurrence of BVF and HVD in the IA group occurred primarily in the smallest TAVR devices (20–23-mm). After excluding these sizes, the cumulative incidences of BVF (IA 5% vs. SA 1%, p = 0.40) and severe HVD (IA 2% vs. SA 1%, p = 0.11) were similar. Conclusion: In this study, TAVR leaflet design had no impact on survival at 10-years. IA devices showed higher transaortic gradients and cumulative incidences of HVD and BVF predominantly occurring in the smallest valve sizes.

Original languageEnglish (US)
Article number924958
JournalFrontiers in Cardiovascular Medicine
StatePublished - Jun 8 2022


  • bioprosthetic valve failure
  • hemodynamic valve deterioration
  • intra-annular
  • supra-annular
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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