Balloon Predilation in Transcatheter Aortic Valve Replacement with Self-expanding Valves

Hasan Rehman, Ankur Kalra, John M. Cochran, Leif Peterson, Sahil Khera, Rishi Puri, Dhaval Kolte, Tanush Gupta, Guilherme F. Attizzani, Deepak L. Bhatt, Colin M. Barker, Michael J. Reardon, Neal S. Kleiman

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ABSTRACTIntroduction: The utility of routine balloon predilation in transcatheter aortic valve replacement (TAVR) with self-expanding valves is not established. Clinical outcomes at 30 days and 1 year post TAVR, deploying the ?no balloon predilation? strategy have not been systematically described.Methods: Between October 2011 and September 2016, all patients who underwent TAVR with self-expanding valves (CoreValve?, Medtronic, Inc., Minneapolis, MN, USA) were stratified into predilation and no predilation groups. Of the 564 patients in the study, predilation was performed in 410 (72.7%) patients.Results: The need for postdilation was less when predilation was performed (30.2%), compared with no predilation (39.0%; adjusted odds ratio [aOR]:0.741, 95% confidence interval [CI]: 0.493?1.114). ?Clinically significant? paravalvular leak (PVL) was similar in the predilation (5.9%) and no predilation (6.8%) groups (aOR: 0.886, 95% CI: 0.398?1.971). Permanent pacemaker implantation was higher following predilation (25.1%), compared with no predilation (15.6%; aOR:3.086, 95% CI:1.413?6.738). There were no differences in 30-day myocardial infarction, or 30-day and 1-year stroke and death. When patients undergoing predilation were further stratified into conservative predilation (predilation balloon size ≤ minimum annulus diameter) and aggressive predilation (predilation balloon size > minimum annulus) groups, need for postdilation was lowest with aggressive predilation. PVL, 30-day and 1-year stroke rates were similar in the aggressive, conservative and no predilation groups.Conclusion: Balloon predilation in TAVR with a self-expanding prosthesis was associated with a significant decrease in the need for balloon postdilation, and a significant increase in the need for a permanent pacemaker. There was no difference in PVL, and 30-day and 1-year stroke and death rates between the two groups.
Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalStructural Heart
StatePublished - Dec 17 2018


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