Improved Hemodynamic Performance and Reduced Paravalvular Regurgitation with the SAPIEN 3 Ultra RESILIA Valve: A Propensity-Matched Single-Center TAVR Study

BackgroundTranscatheter aortic valve replacement (TAVR) has rapidly evolved into a standardized treatment for severe aortic stenosis, particularly in patients at increased surgical risk. The fifth-generation SAPIEN 3 Ultra RESILIA (S3UR) valve notably incorporates RESILIA-treated tissue as well as an enhanced external skirt in order to reduce structural valve deterioration (SVD) and paravalvular leak (PVL). However, real-world data on its clinical performance remains limited. ObjectivesTo evaluate procedural, hemodynamic, and short-term clinical outcomes of the S3UR valve compared to earlier-generation SAPIEN 3 (S3) and SAPIEN 3 Ultra (S3U) platforms in Ronald Raegan UCLA medical center. Methods513 patients who underwent transfemoral TAVR at Ronald Reagan UCLA Medical Center between 2022 and 2024 were analyzed. Of these, 216 received the S3UR valve and 297 received S3U/S3 valves. Propensity-score matching (1:1) yielded 181 well-balanced patient pairs. Primary endpoints included device success per VARC-3 criteria, with secondary endpoints encompassing 30-day safety, echocardiographic performance, and procedural complications. ResultsThe S3UR group demonstrated significantly lower post-procedural and 30-day mean aortic valve gradients (7.45 {+/-} 3.37 mmHg and 9.06 {+/-} 2.94 mmHg, respectively; p < 0.001) compared to the S3U/S3 group. Rates of moderate or greater PVL were 0% in the S3UR group versus 8.9-10.1% in S3U/S3 patients (p < 0.001). Procedural success exceeded 98% in both groups, with no significant differences in stroke, mortality, or new pacemaker implantation. Readmission rates trended lower in the S3UR cohort (7.8% vs. 13.9%), though not statistically significant. ConclusionsThe SAPIEN 3 Ultra RESILIA valve demonstrated superior hemodynamic performance and significantly reduced PVL compared to earlier-generation balloon-expandable valves, while maintaining comparable safety and procedural success. These findings support the S3UR as a preferred TAVR platform in contemporary clinical practice, with ongoing follow-up needed to evaluate long-term durability.