Performance of the Edwards Sapien 3 bioprosthesis in atrioventricular valve position: a case series.

Background: The Edwards Sapien percutaneous valve (Edwards Lifesciences, Irvine, CA, USA) is a promising therapeutic option for congenital atrioventricular disease mostly because of the possibility to accommodate somatic growth with balloon dilatation.

Case summary: This article reports the performance of the Edwards Sapien 3 valve in atrioventricular valve position in four paediatric patients.

Discussion: Despite aggressive antiplatelet and anticoagulation strategies, most patients showed early bioprosthesis dysfunction, with increasing gradient not related with somatic growth. The decrease in leaflet motility in the absence of thrombosis or pannus could be associated with the low-velocity flow and low-pressure gradient that exists between the atria and ventricles in small children. It is well-known graft lifespan is usually shorter in small children, but we hypothesize the possibility of a second factor that valve design is intended to support higher flow-velocity patterns and can present an early failure in low-flow low-pressure situation. More studies are necessary to provide reliable evidence.