Feature | Heart Valve Technology | April 15, 2016

Sapien 3 Outperforms Surgery in ACC.16 Late-breaker

Third-generation device beneficial in intermediate-risk patients with severe aortic stenosis

Sapien III, Sapien 3, PARTNER II

The Sapien 3 valve has a skirt that has helped significantly reduce paravalvular leaks, which were an issue with earlier generation Sapien devices. 

April 15, 2016 — Intermediate-risk patients who received transcatheter aortic valve replacement (TAVR) with the latest-generation valve performed better than patients receiving traditional surgical aortic valve replacement after one year, in a study presented at the American College of Cardiology (ACC) 2016 meeting.

Patients who received the new valve showed improved outcomes for the PARTNER II study’s primary endpoint, a combination of death, stroke and moderate or severe aortic insufficiency, a complication in which blood leaks across the replaced valve. The trial is the first to assess long-term outcomes of TAVR with Sapien 3 in intermediate-risk patients and is in line with findings from an earlier stage of the same study, which showed improved outcomes for Sapien 3 over surgery at 30 days after the procedure. The PARTNER II data was broken into two separate outcomes data based on the use of the Sapien 3 and the earlier generation Sapien XT devices. Positive data was also presented at ACC.16 for the PARTNER IIa results on the Sapien XT valve, where the earlier generation device was found to be equal to surgery. 

“This study shows the lowest mortality rate ever of any transcatheter valve platform after one year, which is very exciting for the management of aortic stenosis,” said lead study author Vinod Thourani, M.D., professor of surgery and medicine at Emory University School of Medicine, chief of cardiothoracic surgery at Emory University Hospital Midtown and the co-director of the Emory Structural Heart and Valve Center. “A previous analysis by our team showed that almost 20 percent of all patients undergoing surgical aortic valve replacement in the United States are in the intermediate-risk category, so I believe that this could have a major impact on the treatment options we have available for many of these patients.”

Watch a video interview with Thourani, about the results at ACC.16.

TAVR is currently approved for patients with severe aortic stenosis whose health profile makes them ineligible or high-risk candidates for open-heart valve replacement surgery. The PARTNER II Trial evaluated outcomes with the Sapien 3 valve, the latest modification of the balloon-expandable system used in these procedures, among intermediate-risk patients.

The trial involved more than 1,000 patients who received TAVR with Sapien 3 at 51 U.S. hospitals. Participants, who averaged nearly 82 years of age, had an STS risk score of 4 to 8, a range considered intermediate, on a scale developed by the Society of Thoracic Surgeons (STS) that quantifies the risks posed by open-heart surgery for a given patient.

To account for baseline differences, TAVR patients were compared by a propensity score analysis with patients randomized to receive surgical intervention in a precursor study, PARTNER IIA. Propensity scoring analysis is a statistical technique used to reduce bias from potential confounding variables, which in this case was used to identify surgical patients from a previous study who would be comparable to TAVR patients in this study.

In the study’s primary endpoint, a composite of death, stroke and moderate or severe aortic insufficiency, TAVR was found to be superior to surgery at one year, occurring 9.2 percent less in the TAVR patients compared with surgery patients. TAVR was also superior to surgery for two out of three secondary outcomes, mortality and stroke. In unadjusted one-year outcomes, all-cause mortality was lower with TAVR, occurring in only 7.4 percent of TAVR patients as compared to 13 percent of patients receiving surgery. The rate of disabling strokes was also lower in TAVR patients, at 4.6 percent as compared to 8.2 percent in surgery patients.

Watch a video explaining the improved stroke rates with the Sapien valve at ACC.16

Surgery was found to be superior to TAVR in moderate to severe aortic insufficiency, occurring in 1.5 percent of TAVR patients and in 0.4 percent of surgery patients. More than moderate aortic insufficiency has been associated with poorer outcomes after TAVR in past studies. In addition, TAVR patients needed pacemakers at a slightly higher rate at one year than did patients receiving surgery.

“Taken together, these results demonstrate substantial improvements in outcomes among intermediate- risk patients receiving the Sapien 3 valve as compared in a propensity score analysis in intermediate- risk patients receiving surgery,” Thourani said. In addition, the intermediate-risk TAVR patients in the new trial showed marked improvements in outcomes as compared to high-risk TAVR patients in previous trials.

Several factors could account for the overall improved success of the Sapien 3 TAVR procedure, Thourani said. One is that the third-generation model has been modified with an outer skirt designed to reduce leaking by sealing gaps around the valve. Other alterations allow the valve to be delivered with a smaller catheter, increasing the percentage of procedures that can be performed via the femoral artery accessed through the groin, a route that is considered safer. Nearly 90 percent of TAVR procedures in the new trial were performed through the femoral artery. In addition, heart teams now have more experience performing TAVR, and improved imaging techniques have allowed physicians to utilize more precise information about the valve implantation site and the appropriate valve size.

“Because our techniques have significantly improved, the majority of these patients go home within a day or two after the procedure,” Thourani said. “The improvements with the Sapien 3 valve have made this an easier procedure to perform and now this study shows that we can do it with extremely low complications and mortality. I believe we are on the cusp of a new indication for TAVR.”

Patients in the trial will continue be followed for five years.

The study was funded by Edwards Lifesciences. Thourani serves on research advisory boards at Edwards Lifesciences, Medtronic, Boston Scientific and St. Jude Medical.

This study was simultaneously published online in The Lancet at the time of presentation. 

Related Content

The American College of Cardiology (ACC) released a list of the latest practice-changing presentations at the ACC.20 annual meeting March 28-30, 2020, in Chicago. This includes five late-breaking clinical trial (LBCT) sessions and three featured clinical research sessions. There also are two LBCT deep-dive sessions where the experts will break down the hottest trials and attendees can find out what the impact might be on the practice of cardiology and patients.
Feature | ACC | April 09, 2020 | Dave Fornell, Editor
Here is the list of American College of Cardiology (ACC) practice-
ACC Cancels 2020 Conference Amid Coronavirus Concerns. #COVID19 #coronavirus #2019nCoV
Feature | ACC | March 09, 2020 | Dave Fornell, Editor
March 9, 2020 — Less than week after the American College of Cardiolog...
American College of Cardiology Names Douglas Drachman Next Annual Scientific Session Vice Chair

Image courtesy of Massachusetts General Hospital

News | ACC | October 08, 2019
Douglas Drachman, M.D., FACC, has been selected as the next vice chair of the American College of Cardiology’s (ACC)...
SyncVision iFR Co-registration from Philips Healthcare maps pressure readings onto angiogram. Results from an international study presented at ACC 2019 indicates pressure readings obtained using iFR (instantaneous wave-free ratio, also referred to as instant wave-free ratio or instant flow reserve) in coronary arteries may localize stenoses that remain after interventions. FFR in the cath lab.

SyncVision iFR Co-registration from Philips Healthcare maps pressure readings onto angiogram. Results from an international study presented at ACC 2019 indicates pressure readings obtained using iFR (instantaneous wave-free ratio, also referred to as instant wave-free ratio or instant flow reserve) in coronary arteries may localize stenoses that remain after interventions.

Feature | ACC | March 27, 2019 | Greg Freiherr, Contributing Editor
The fingerprints of value-added medicine were all over products and works-in-progress on the exhibit floor of the a

The opening late-breaking trial at ACC 2019 is the Apple Heart Study, a large-scale, app-based study to identify atrial fibrillation using a smartwatch. Earlier, smaller trials showed this approach might be used in a population health application to proactively identify AFib patients earlier.

Feature | ACC | March 19, 2019
The American College of Cardiology (ACC) released a list of the late
A patient who received HeartMate III LVAD system at ACC.18. The HeartMate 3 was the topic of of the the key late-breaking trials at #ACC18

A patient who received the HeartMate III LVAD system showing off his external battery pack. He served as a patient ambassador in the Abbott booth at ACC.18. The HeartMate III, with its magnetic levitated pump, showed a big reduction in clotting over previous LVADs in a key late-breaking trial at this year's conference.

Feature | ACC | March 27, 2018 | Dave Fornell
There were several notable presentations of new data on cardiovascular technologies at the recent 2018 American Colle
Drug Stops Dangerous Bleeding in Patients Taking Factor Xa Inhibitors


News | ACC | March 22, 2018
March 22, 2018 — The experimental drug...
Videos | ACC | March 21, 2018
DAIC Editor Dave Fornell takes a tour of some of the most interesting new technologies on the expo floor at
ACC 2018 Late-Breaking Trials Announced
News | ACC | March 21, 2018
Here is a list of the American College of Cardiology (ACC) 2018 annual meeting late-breaking clinical trials presente
Inhaled Therapy Ineffective in Difficult-to-Treat Heart Failure at ACC 2018.

Image from presentation, "Inorganic Nitrite Delivery to Improve Exercise Capacity in HFpEF: The INDIE-HFpEF Trial," Borlaug

News | ACC | March 20, 2018
March 20, 2018 — Four weeks of treatment with a novel inhaled medication failed to improve exercise capacity, daily a