Original Studies Comparison of Acute Elastic Recoil Between the SAPIEN-XT and SAPIEN Valves in Transfemoral– Transcatheter Aortic Valve Replacement Aatish Garg, 1 MD, Akhil Parashar, 1 MD, Shikhar Agarwal, 2 MD, MPH, Olcay Aksoy, 2 MD, Muhammad Hammadah, 1 MD, Kanhaiya Lal Poddar, 2 MD, Rishi Puri, 2 MD, Lars G. Svensson, 3 MD, PhD, Amar Krishnaswamy, 2 MD, E. Murat Tuzcu, 2 MD, FACC, and Samir R. Kapadia, 2 * MD, FACC Background: The SAPIEN-XT is a newer generation balloon-expandable valve created of cobalt chromium frame, as opposed to the stainless steel frame used in the older generation SAPIEN valve. We sought to determine if there was difference in acute recoil between the two valves. Methods: All patients who underwent transfemoral– transcatheter aortic valve replacement using the SAPIEN-XT valve at the Cleveland Clinic were included. Recoil was measured using biplane cine-angiographic image analysis of valve deployment. Acute recoil was defined as [(valve diameter at maximal balloon inflation) 2 (valve diameter after deflation)]/valve diameter at maximal balloon inflation (reported as percentage). Patients undergoing SAPIEN valve implantation were used as the comparison group. Results: Among the 23 mm valves, the mean (standard deviation—SD) acute recoil was 2.77% (1.14) for the SAPIEN valve as com- pared to 3.75% (1.52) for the SAPIEN XT valve (P 5 0.04). Among the 26 mm valves, the mean (SD) acute recoil was 2.85% (1.4) for the SAPIEN valve as compared to 4.32% (1.63) for the SAPIEN XT valve (P 5 0.01). Multivariable linear regression analysis dem- onstrated significantly greater adjusted recoil in the SAPIEN XT valves as compared to the SAPIEN valves by 1.43% [(95% CI: 0.69–2.17), P < 0.001]. However, the residual peak gradient was less for SAPIEN XT compared to SAPIEN valves [18.86 mm Hg versus 23.53 mm Hg (P 5 0.01)]. Additionally, no difference in paravalvular leak was noted between the two valve types (P 5 0.78). Conclusions: The SAPIEN XT valves had signif- icantly greater acute recoil after deployment compared to the SAPIEN valves. Implica- tions of this difference in acute recoil on valve performance need to be investigated in future studies. V C 2014 Wiley Periodicals, Inc. Key words: transcatheter valve implantation; aortic valve disease; aortic valve disease; percutaneous intervention 1 Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio 44195 2 Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio 44195 3 Department of Thoracic and Cardiovascular Surgery, Cleve- land Clinic, Cleveland, Ohio 44195 Disclosure: We the authors have no relevant conflicts of interest to report. Aatish Garg and Akhil Parashar contributed equally to this work and should be considered co-primary authors. *Correspondence to: Samir R. Kapadia, MD FACC, Professor of Medicine and Director, Sones Cardiac Catheterization Laboratories, Heart and Vascular Institute, J2-3, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195. E-mail: kapadis@ccf.org Received 18 May 2014; Revision accepted 25 October 2014 DOI: 10.1002/ccd.25717 Published online 00 Month 2014 in Wiley Online Library (wileyonlinelibrary.com) V C 2014 Wiley Periodicals, Inc. Catheterization and Cardiovascular Interventions 00:00–00 (2014)