TAVR with the SAPIEN 3 valve: Better than surgery for intermediate-risk patients*

Transforming aortic valve replacement therapy

Transcatheter aortic valve replacement (TAVR) with the SAPIEN 3 valve demonstrated 75% lower rates of 30-day all-cause mortality and disabling stroke compared to surgery in intermediate-risk patients.

Intermediate Risk data

All Cause Mortality
Disabling Stroke
SAPIEN 3 Intermediate-Risk

Potential TAVR candidate

Potential candidate eligibility now includes all patients suffering from symptomatic severe aortic stenosis unless determined to be at low surgical risk.

Learn more

*The PARTNER II Trial intermediate-risk cohort, VI population (n=2,005); the difference in the primary endpoint (composite of all-cause mortality, all stroke, and ≥ moderate aortic regurgitation at one year) event rate between TAVR with the SAPIEN 3 valve and surgery appeared to be clinically significant.
The PARTNER II Trial intermediate-risk cohort 30-day unadjusted clinical event rates for TAVR with the SAPIEN 3 valve, AT population (n=1,077).
The PARTNER II Trial intermediate-risk cohort unadjusted clinical event rates, AT population.
Learn more about the definitive outcomes with the SAPIEN 3 valve
Severe aortic stenosis

Aortic valve stenosis — or aortic stenosis — occurs when the heart's aortic valve narrows. This narrowing prevents the valve from opening fully, which obstructs blood flow from the heart into the aorta and onward to the rest of the body. Usually when aortic valve stenosis becomes severe and symptomatic, the native valve should be replaced. Left untreated, aortic valve stenosis may lead to sudden death.

congenital abnormality
Images courtesy of John Webb, MD at St. Paul's Hospital and Renu Virmani, MD at the CVPath Institute

Approx. 2.5 Million People In The U.S. Over The Age Of 75 Suffer From This Disease.1

  • Aortic stenosis is estimated to be prevalent with 12.4% of the population over the age of 75.2
  • The elderly population will more than double between now and the year 2050, to 80 million.3
  • 80% of adults with symptomatic aortic stenosis are male4

The symptoms of aortic disease are commonly misunderstood by patients as 'normal signs of aging.'5 Many patients initially appear asymptomatic, but on closer examination up to 37% exhibit symptoms.6

Sandy - Severe Aortic Stenosis Sandy - severe aortic stenosis
(actual patient)

Severe aortic stenosis is life threatening and treatment is critical

After the onset of symptoms, patients with severe aortic stenosis have a survival rate as low as:

  • 50% at 2 years
  • 20% at 5 years without aortic valve replacement7
  1. U.S. Census Bureau. Population Division. June 2015.
  2. Ruben L.J., et al. Aortic Stenosis in the Elderly. Disease Prevalence and Number Candidates for Transcatheter Aortic Valve Replacement: A Meta-Analysis and Modeling Study. J AM Coll Cardiol. 2013;62:1002-1012.
  3. U.S. Census Bureau Statistical Brief. May 1995.
  4. Ramaraj R, Sorrell V. Degenerative aortic stenosis. BMJ 2008;336:550-5.
  5. Alliance for Aging Research Website.
  6. Das P. Exercise testing to stratify risk in aortic stenosis. European Heart Journal. 2005; 26:1309-1313.
  7. Otto CM. VALVE DISEASE: Timing of aortic valve surgery. Heart. 2000;84(2):211-218.
  8. Lester S, Heilborn B, Dodek A, Gin K, Jue J. The Natural History and Rate of Progression of Aortic Stenosis. Chest. 1998; 113(4):1109.
AHA / ACC valvular disease guidelines

Definition of severe aortic stenosis9

DefinitionValve Hemodynamics
High-gradient severe aortic stenosis
  • Aortic jet ≥ 4 m/s or mean gradient ≥ 40 mmHg
  • Or aortic valve area index ≤ 0.6 cm 2 /m 2
Low-flow / low-gradient with reduced left ventricular ejection fraction
  • Resting aortic jet velocity < 4m/s or mean gradient < 40 mmHg
  • Dobutamine stress echocardiography shows aortic valve area ≤ 1.0 cm 2 with aortic jet velocity ≥ 4m/s at any flow rate
  • Left ventricular ejection fraction <50%
Low-gradient with normal left ventricular ejection fraction or paradoxical low-flow
  • Aortic jet velocity < 4m/s or mean gradient < 40 mmHg
  • Indexed aortic valve area ≤ 06 cm 2 /m 2
  • Stroke volume index < 35 mL/m 2 measured when patient is normotensive (systolic blood pressure < 140 mmHg)
  • Left ventricular ejection fraction ≥ 50%

9JACC Vol. 63, No 22, 20142014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease (June 10, 2014).

Important safety information

Edwards SAPIEN 3 transcatheter heart valve with the Edwards Commander delivery system

Important safety information

Edwards SAPIEN 3 transcatheter heart valve with the Edwards Commander delivery system

Indications: The Edwards SAPIEN 3 transcatheter heart valve, model 9600TFX, and accessories are indicated for relief of aortic stenosis in patients with symptomatic heart disease due to severe native calcific aortic stenosis who are judged by a Heart Team, including a cardiac surgeon, to be at intermediate or greater risk for open surgical therapy (i.e., predicted risk of surgical mortality ≥ 3% at 30 days, based on the Society of Thoracic Surgeons (STS) risk score and other clinical co-morbidities unmeasured by the STS risk calculator).

Contraindications: The valve and delivery systems are contraindicated in patients who cannot tolerate an anticoagulation/antiplatelet regimen or who have active bacterial endocarditis or other active infections.

Warnings: Observation of the pacing lead throughout the procedure is essential to avoid the potential risk of pacing lead perforation. There may be an increased risk of stroke in transcatheter aortic valve replacement procedures, as compared to balloon aortic valvuloplasty or other standard treatments in high or greater risk patients. The devices are designed, intended, and distributed for single use only. Do not resterilize or reuse the devices. There are no data to support the sterility, nonpyrogenicity, and functionality of the devices after reprocessing. Incorrect sizing of the valve may lead to paravalvular leak, migration, embolization, and/or annular rupture. Accelerated deterioration of the valve may occur in patients with an altered calcium metabolism. Prior to delivery, the valve must remain hydrated at all times and cannot be exposed to solutions other than its shipping storage solution and sterile physiologic rinsing solution. Valve leaflets mishandled or damaged during any part of the procedure will require replacement of the valve. Caution should be exercised in implanting a valve in patients with clinically significant coronary artery disease. Patients with pre-existing mitral valve devices should be carefully assessed prior to implantation of the valve to ensure proper valve positioning and deployment. Do not mishandle the delivery system or use it if the packaging or any components are not sterile, have been opened or are damaged (e.g., kinked or stretched), or if the expiration date has elapsed. Use of excessive contrast media may lead to renal failure. Measure the patient’s creatinine level prior to the procedure. Contrast media usage should be monitored. Patient injury could occur if the delivery system is not un-flexed prior to removal. Care should be exercised in patients with hypersensitivities to cobalt, nickel, chromium, molybdenum, titanium, manganese, silicon, and/or polymeric materials. The procedure should be conducted under fluoroscopic guidance. Some fluoroscopically guided procedures are associated with a risk of radiation injury to the skin. These injuries may be painful, disfiguring, and long-lasting. Valve recipients should be maintained on anticoagulant/antiplatelet therapy, except when contraindicated, as determined by their physician. This device has not been tested for use without anticoagulation.

Precautions: Long-term durability has not been established for the valve. Regular medical follow-up is advised to evaluate valve performance. Glutaraldehyde may cause irritation of the skin, eyes, nose, and throat. Avoid prolonged or repeated exposure to, or breathing of, the solution. To maintain proper valve leaflet coaptation, do not overinflate the deployment balloon. Appropriate antibiotic prophylaxis is recommended post-procedure in patients at risk for prosthetic valve infection and endocarditis. Safety, effectiveness, and durability have not been established for valve-in-valve procedures. Safety and effectiveness have not been established for patients with the following characteristics/comorbidities: non-calcified aortic annulus; severe ventricular dysfunction with ejection fraction < 20%; congenital unicuspid or congenital bicuspid aortic valve; mixed aortic valve disease (aortic stenosis and aortic regurgitation with predominant aortic regurgitation > 3+); pre-existing prosthetic heart valve or prosthetic ring in any position; severe mitral annular calcification (MAC), severe (> 3+) mitral insufficiency, or Gorlin syndrome; blood dyscrasias defined as leukopenia (WBC < 3000 cells/mL), acute anemia (Hb < 9 g/dL), thrombocytopenia (platelet count < 50,000 cells/mL), or history of bleeding diathesis or coagulopathy; hypertrophic cardiomyopathy with or without obstruction (HOCM); echocardiographic evidence of intracardiac mass, thrombus, or vegetation; a known hypersensitivity or contraindication to aspirin, heparin, ticlopidine (Ticlid), or clopidogrel (Plavix), or sensitivity to contrast media, which cannot be adequately premedicated; significant aortic disease, including abdominal aortic or thoracic aneurysm defined as maximal luminal diameter 5 cm or greater, marked tortuosity (hyperacute bend), aortic arch atheroma (especially if thick [> 5 mm], protruding, or ulcerated) or narrowing (especially with calcification and surface irregularities) of the abdominal or thoracic aorta, severe “unfolding” and tortuosity of the thoracic aorta; access characteristics that would preclude safe placement of 14F or 16F Edwards eSheath introducer set, such as severe obstructive calcification, severe tortuosity, or diameter less than 5.5 mm or 6 mm, respectively; or bulky calcified aortic valve leaflets in close proximity to coronary ostia.

Potential adverse events: Potential risks associated with the overall procedure including potential access complications associated with standard cardiac catheterization, balloon valvuloplasty, the potential risks of conscious sedation and/or general anesthesia, and the use of angiography: death; stroke/transient ischemic attack, clusters, or neurological deficit; paralysis; permanent disability; respiratory insufficiency or respiratory failure; hemorrhage requiring transfusion or intervention; cardiovascular injury including perforation or dissection of vessels, ventricle, myocardium, or valvular structures that may require intervention; pericardial effusion or cardiac tamponade; embolization including air, calcific valve material, or thrombus; infection including septicemia and endocarditis; heart failure; myocardial infarction; renal insufficiency or renal failure; conduction system defect which may require a permanent pacemaker; arrhythmia; retroperitoneal bleed; arteriovenous(AV) fistula or pseudoaneurysm; reoperation; ischemia or nerve injury; restenosis; pulmonary edema; pleural effusion; bleeding; anemia; abnormal lab values (including electrolyte imbalance); hypertension or hypotension; allergic reaction to anesthesia, contrast media, or device materials; hematoma; syncope; pain or changes at the access site; exercise intolerance or weakness; inflammation; angina; heart murmur; and fever. Additional potential risks associated with the use of the valve, delivery system, and/or accessories include: cardiac arrest; cardiogenic shock; emergency cardiac surgery; cardiac failure or low cardiac output; coronary flow obstruction/ transvalvular flow disturbance; device thrombosis requiring intervention; valve thrombosis; device embolization; device migration or malposition requiring intervention; valve deployment in unintended location; valve stenosis; structural valve deterioration (wear, fracture, calcification, leaflet tear/tearing from the stent posts, leaflet retraction, suture line disruption of components of a prosthetic valve, thickening, stenosis); device degeneration; paravalvular or transvalvular leak; valve regurgitation; hemolysis; device explants; nonstructural dysfunction; mechanical failure of delivery system and/or accessories; and non-emergent reoperation.

Edwards crimper

Indications: The Edwards crimper is indicated for use in preparing the Edwards SAPIEN 3 transcatheter heart valve for implantation.

Contraindications: There are no known contraindications.

Warnings: The devices are designed, intended, and distributed for single use only. Do not resterilize or reuse the devices. There is no data to support the sterility, nonpyrogenicity, and functionality of the devices after reprocessing.

Precautions: For special considerations associated with the use of the Edwards crimper prior to valve implantation, refer to the Edwards SAPIEN 3 transcatheter heart valve Instructions for Use.

Potential adverse events: There are no known potential adverse events associated with the Edwards crimper.

Caution: Federal (United States) law restricts these devices to sale by or on the order of a physician.

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