hemodynamic characteristics of edwards sapien aortic valve prosthesis assessed with transesophageal echocardiography background and aim of the study transcatheter aortic valve implantation tavi has become the therapy of choice in highrisk patients with aortic stenosis transesophageal echocardiography provides important anatomic and functional information before during and after any procedure the study aim was to determine the hemodynamic properties of 23 and 26 mm edwards sapien es valves immediately after implantation and to compare these data to those previously reported for surgically implanted valvesmethods a total of 284 patients treated with transapical tavi 90 patients with es 23 mm valves 194 with es 26 mm valves for severe aortic stenosis was analyzed quantitative echocardiographic data were obtained both pre and postprocedure and stored measurements were also made of the aortic annulus diameter and the effective orifice area eoa was also calculated in addition the effective energy loss coefficient as a parameter of left ventricular lv workload assessment was determined for risk estimation of prosthesispatient mismatch ppm the eoa was indexed by body surface area typically an ieoa value 065 cm2m2 was considered indicative of ppmresults the lv systolic function assessed as biplane ejection fraction ef was improved significantly preprocedure 53 17 versus postprocedure 59 14 p 00001 the improvement was more pronounced in patients with a reduced preoperative function correlation between aef and ef pre r 055 p 000001 the peak postprocedure pressure gradients in the 23 mm and 26 mm groups were 119 63 and 95 52 mmhg respectively the mean pressure gradient was 63 34 and 50 26 mmhg and the eoa was 155 036 and 185 042 cm2 in 72 of all patients 101 in the 23 mm group and 58 in the 26 mm group p 030 the postprocedure ieoa was below the borderline value for ppmconclusion the main hemodynamic characteristics of the edwards sapien valves were low peak and mean pressure gradients and a low incidence of ppm after tavi the eoa was highly comparable with that of stented and stentless biological prostheses used for conventional aortic valve surgery an ability to maintain these favorable hemodynamic characteristics of the es valves during a longterm follow up would serve as a strong argument to extend the indication for tavi to lowerrisk patients