Clinical and hemodynamic results after direct transcatheter aortic valve replacement versus pre‐implantation balloon aortic valvuloplasty: A case‐matched analysis

Abstract

Direct transfemoral TAVR without prior BAV was safe in patients with calcified severe aortic stenosis. Pre-implantation BAV could be omitted in patients undergoing TAVR, without influence in procedure success rate, and subsequent patients' clinical course and valve hemodynamic performance. © 2016 Wiley Periodicals, Inc.

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.…”

“…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.…”

Predilatation for transcatheter aortic valve replacement: Still have a role?

“…Ferrera C, et al, reported a case‐matched analysis in total of 339 patients (102 patients with BAV and 102 direct TAVR) using both self‐expanding and balloon expandable valve platforms which were prospectively selected. A 1:1 matching was conducted, pairing for age, prosthesis type, size, and valvular calcification as 48% of them had moderate to severe valvular calcification.…”