Preparatory Balloon Aortic Valvuloplasty During Transcatheter Aortic Valve Implantation for Improved Valve Sizing

Abstract

Preparatory balloon aortic valvuloplasty during transcatheter aortic valve implantation improves valve size selection, reduces the associated PAR, and increases survival in borderline cases.

Non‐invasive and Invasive Predictors of Paravalvular Regurgitation Post CoreValve® Stent Prosthesis Implantation in Aortic Valves

“…The implanted CoreValve stent size (26 or 29 mm, 31 mm) seems to be an independent predictor of severe PVR. It is tempting to speculate that potential inaccuracies in the preprocedural measurement of the annulus diameter, using cardiac CT or transesophageal echocardiography, lead to inappropriate stent size selection and subsequent postprocedural PVR . Although we observed a significantly higher degree of PVR in subjects who received a 29 mm prosthesis (n = 50) compared to those who received a 26 mm prosthesis (n = 44), we did not find a significant difference in the small subgroup (n = 6) of patients who received a 31 mm prosthesis.…”

“…In the light of these findings, first, choice of CoreValve should be considered with caution if the evaluated parameters predict a high likelihood of severe PVR. If 1 of the 3 parameters (see above) would estimate postprocedural severe PVR, the physicians should consider a different aortic valve replacement device, that is, Edwards Lifescience SAPIEN Transcatheter Heart Valve System, or consider open heart surgery …”

Balloon‐Expandable Transcatheter Aortic Valves Can Be Successfully and Safely Implanted Transfemorally Without Balloon Valvuloplasty

“…[2][3][4] Theoretically, it could help with ensuring easy passage of the new valve through the old one and allow better deployment with reduced paravalvular leak, as well as help in sizing of the valve. 5 However, the necessity of BAV is unknown and currently sizing is predominantly done using 3D computerized tomography or even 3D transesophageal echocardiography. 6,7 Conversely, avoiding the BAV could theoretically reduce time taken for the procedure, reduce ionizing radiation exposure, and reduce the number of cerebral emboli that are known to occur during the BAV procedure.…”

Transfemoral TAVI without pre-dilatation using balloon-expandable devices: a case-matched analysis

“…Also, BAV is thought to promote adequate apposition of the THV stent to the annulus with optimal stent expansion and good functional results without paravalvular leakage (PVL). Furthermore, BAV has been advocated to predict displacement of coronary leaflets during TAVI or as a sizing tool [8] even though multi-slice contrast-enhanced computed tomography is increasingly being recognized as the planning modality of choice [9,10].…”