Aortic Valve Predilatation with a Small Balloon, without Rapid Pacing, prior to Transfemoral Transcatheter Aortic Valve Replacement

Abstract

Objectives The aim of this study is to assess the feasibility and clinical outcome of transcatheter aortic valve replacement (TAVR) using aortic valve predilatation (AVPD) with a small, nonocclusive balloon. Background Balloon aortic valvuloplasty (BAV) under rapid pacing is generally performed in TAVR to ensure the passage and sufficient deployment of the prosthesis in the stenotic AV. BAV may cause serious complications, such as left ventricular stunning or cerebrovascular embolism. Methods A cohort of 50 consecutive patients with severe aortic stenosis underwent transfemoral TAVR with the Edwards Sapien 3-heart valve. All patients underwent AVPD with a small, nonocclusive balloon (12 × 60 or 14 × 60 mm) without rapid pacing. Procedural data and clinical outcomes were analyzed. Results The mean age of the cohort was 81 ± 6 years and the mean logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) was 13 ± 9. Crossing the AV and prosthesis implantation was successful in all cases. The postprocedural mean AV gradient was 12 ± 5 mmHg. There were no cases of aortic regurgitation ≥ grade 2. No periprocedural stroke occurred. One patient (2%) with chronic atrial fibrillation displayed a transient Wernicke aphasia occurring more than 24 hours after TAVR. Mortality was 0% at 30 days after procedure. Conclusion In TAVR, AVPD with a small, nonocclusive balloon can be safely performed. By avoiding rapid pacing, this technique may be a valid alternative to traditional BAV. Whether or not the use of APVD without rapid pacing translates into less periprocedural complications needs to be assessed in future studies.

Aortic valve replacement using valve-in-valve procedure in a patient with left atrial appendage thrombus

“…However, rapid ventricular pacing has several disadvantages such as left ventricular stunning, decreased cardiac output, and stroke. [4] It has been also shown that stroke rates are lower in patients without balloon aortic valvuloplasty. [5] In order to reduce the risk for stroke, the choice of self-expandable valve which does not always require balloon predilatation may be considered.…”

Balloon aortic valvuloplasty in degenerative aortic stenosis

“…публикуват серия от 50 пациенти, които получават предилатация преди TAVI с малък балон -12 mm или 14 mm. Поради малкия размер на балона по време на предилатация, те не използват RVP [24]. Въпреки факта, че серията е сравнително малка, за да се оцени адекватно безо-пасността и ефикасността на този метод, резултати на колегите предполагат че "малката" балонна предилатация вероятно осигурява достатъчeн отвор на клапана за преминаване и манипулиране с нископрофилна протеза от ново поколение.…”

Computational Analysis of Balloon Catheter Behaviour at Variable Inflation Levels

“…Despite its frequent use, RVP is associated with several potential complications, e.g., cardiac perforation, tamponade, and arrhythmia, including ventricular tachycardia [6], [7]. To avoid RVP, recent studies have focused on improving balloon catheter design by investigating small, non-occlusive balloon catheters, or multi-compartment balloon catheters [8], [9]. However, incomplete dilation and substantial backflow from the aorta to the left ventricle through the large central orifice of these balloon catheter necessarily introduces major alterations to the physiological flow and energetic losses.…”