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

Abstract

TAVI can be effectively and safely performed without a BAV and this results in reduced procedural and fluoroscopic times, although embolization to the brain is not reduced. There is a trend toward reduced stroke risk. (J Interven Cardiol 2016;29:319-324).

Routine Predeployment Balloon Aortic Valvuloplasty During Transcatheter Aortic Valve Replacement: Time to Move On?

“…Hence, to decrease cerebral emboli during TAVR, emphasis should be made on careful manipulation of catheters in the aortic arch, conscientious anticoagulation, and possibly prophylactic use of an embolic protection device. The present study indicates that BAV during TAVR does not increase the incidence of procedure‐related stroke, which correlates with the bulk of previous evidence . This finding particularly applies to TAVR performed at experienced centers and when third‐generation valves are used.…”

“…As centers continue to gain experience, physicians are likely to become more comfortable with direct TAVR. This trend has already transpired in the design of recent trials, in the UK registry from 2007 to 2014 as presented in this study, and in the Italian registry where routine predeployment BAV rates have dropped from 91.7% in 2013 to 80.7% in 2015 …”

“…These results add to the existing data supporting that TAVR can be performed successfully without routine BAV. Omitting this additional step has been shown to be safe, results in successful valve deployment, and yields similar clinical and hemodynamic outcome at up to 1 year . Additional benefits of direct TAVR are lower contrast use and shorter fluoroscopy and procedural time .…”

“…Omitting this additional step has been shown to be safe, results in successful valve deployment, and yields similar clinical and hemodynamic outcome at up to 1 year . Additional benefits of direct TAVR are lower contrast use and shorter fluoroscopy and procedural time . Nonetheless, other uses for nonroutine predeployment BAV, such as balloon sizing for confirmation of annulus dimension and evaluation of the interaction of the native leaflets with the coronary ostia when coronary artery takeoffs are low, continue to have a role in the contemporary TAVR era.…”

“…It has been suggested that direct TAVR can require more frequent postdilation, which is associated with increased cerebral embolic events . However, most trials have not found a difference in the rate of postdilation between direct TAVR and predeployment BAV . Again, BAV does not appear to significantly impact outcomes in TAVR, but its safety and association with stroke using third‐generation valves need to be validated in large randomized trials.…”