Focused Issue: Transcatheter Valve Interventions
Clinical Research
Predictive Factors, Efficacy, and Safety of Balloon Post-Dilation After Transcatheter Aortic Valve Implantation With a Balloon-Expandable Valve

https://doi.org/10.1016/j.jcin.2012.02.010Get rights and content
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Objectives

This study sought to evaluate the predictive factors, effects, and safety of balloon post-dilation (BPD) for the treatment of significant paravalvular aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI).

Background

Very few data exist on BPD after TAVI with a balloon-expandable valve.

Methods

A total of 211 patients who underwent TAVI with a balloon-expandable valve were included. BPD was performed after TAVI if paravalvular AR ≥2 was identified by transesophageal echocardiography. Clinical events and echocardiographic data were prospectively recorded, and median follow-up was 12 (6 to 24) months.

Results

BPD was performed in 59 patients (28%), leading to a reduction in at least 1 degree of AR in 71% of patients, with residual AR <2 in 54% of the patients. The predictors of the need for BPD were the degree of valve calcification and transfemoral approach, with valve calcification volume >2,200 and >3,800 mm3 best determining the need for and a poor response to BPD, respectively. Patients who underwent BPD had a higher incidence of cerebrovascular events at 30 days (11.9% vs. 2.0%, p = 0.006), with most (83%) events within the 24 h after the procedure occurring in patients who had BPD. No significant changes in valve area or AR degree were observed at follow-up in BPD and no-BPD groups.

Conclusions

BPD was needed in about one-fourth of the patients undergoing TAVI with a balloon-expandable valve and was successful in about one-half of them. A higher degree of valve calcification and transfemoral approach predicted the need for BPD. BPD was not associated with any deleterious effect on valve function at mid-term follow-up, but a higher rate of cerebrovascular events was observed in patients who had BPD.

Key Words

balloon post-dilation
stroke
transapical
transcatheter aortic valve implantation
transcatheter aortic valve replacement
transfemoral

Abbreviations and Acronyms

AR
aortic regurgitation
BPD
balloon post-dilation
CI
confidence interval
CT
computed tomography
MLD
minimal lumen diameter
OR
odds ratio
ROC
receiver-operating characteristic
TAVI
transcatheter aortic valve implantation
TEE
transesophageal echocardiography
TF
transfemoral

Cited by (0)

Dr. Nombela-Franco received funding via a research grant from the Fundación Alfonso Martín Escudero (Spain). Dr. Rodés-Cabau is a consultant for Edwards Lifesciences, Inc. and St. Jude Medical. Dr. DeLarochellière is a consultant for St. Jude Medical. Dr. Urena received a grant from the Sociedad Española de Cardiologia. Dr. Dumont is a consultant for Edwards Lifesciences, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.