Determinants of success and hemodynamic impact of balloon postdilatation of self‐expanding transcatheter aortic valves

Abdelghani, Mohammad; Winter, Robbert J. de; Miyazaki, Yosuke; Modolo, Rodrigo; Tateishi, Hiroki; Cavalcante, Rafael; Sarmento‐Leite, Rogério; Mangione, José Armando; Abizaid, Alexandre; Soliman, Osama Ibrahim Ibrahim; Onuma, Yoshinobu; Lemos, Pedro A.; Serruys, Patrick W.; Brito, Fábio Sândoli de

doi:10.1002/ccd.27538

Cited by 3 publications

(1 citation statement)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The ratio of the post-dilation balloon diameter to the annulus diameter was greater in patients treated successfully with post-dilation vs. those treated unsuccessfully (post-dilation balloon size/mean annulus diameter 1.04 ± 0.11 vs. 0.95 ± 0.10, P = 0.007) where a post-dilation balloon size of <95% of the mean annulus diameter had a tenfold higher chance of failure to optimize PVR. 110 When asymmetrical large calcium deposits prevent full stent frame apposition, post-dilation has been reported to be associated with peri-aortic haematoma and annular or landing zone rupture, which carries a high mortality. 111 Therefore, post-dilation should be performed with a balloon size that equals at least >95% of the CT-derived mean annulus diameter.…”

Section: Treatment Of Pvrmentioning

confidence: 99%

Paravalvular regurgitation after transcatheter aortic valve replacement: incidence, quantification, and prognostic impact

van Wely,

Rooijakkers,

Stens

et al. 2024

European Heart Journal - Imaging Methods and Practice

View full text Add to dashboard Cite

Transcatheter aortic valve replacement (TAVR) is standard of care in aortic stenosis (AS) with results comparable to surgical aortic valve replacement (SAVR). However, paravalvular regurgitation (PVR) is more common after TAVR. With the alteration of devices and implantation techniques, the incidence of moderate or more PVR has declined. Mild PVR is still common in around 30% of TAVR patients in low risk trials. Progression of AS causes myocardial hypertrophy and varying degrees of diastolic dysfunction which may cause heart failure even in combination with small volumes of PVR. Any degree of PVR is associated with increased risk of overall and cardiovascular mortality. Predictors of PVR are annular eccentricity, severe calcification of the aortic valve, bicuspid aortic valves, and type of prosthesis where balloon-expandable devices are associated with less PVR. PVR is diagnosed using echocardiography, aortic angiogram with or without videodensitometry, hemodynamic parameters, or cardiac magnetic resonance (CMR). PVR can be treated using post-dilation, interventional treatment using a vascular plug, or implantation of a second device. Successful post-dilation depends on balloon size which should at least be equal to or more than 95% of the mean annulus diameter. Implantation of a second device to reduce PVR is successful in approximately 90% of cases, either through lengthening of the sealing skirt in case of inadequate position or through further expansion of the index device. Implantation of a vascular plug can successfully reduce PVR and reduce mortality.

show abstract

Section: Treatment Of Pvrmentioning

confidence: 99%