Feasibility and safety of balloon-expandable transcatheter aortic valve implantation with moderate or without predilatation

Abstract

Balloon-expandable TAVI with moderate or without balloon PD is feasible and safe. The omission of PD in appropriate cases was associated with reduced fluoroscopy time without affecting procedural success.

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

“…Our results were in accordance to previous studies in terms of simplifying the procedure with shorter procedural time and lower contrast use. Consequently, AKI (stages 2 and 3), which is a well‐known prognosis marker in TAVR population , was significantly lower in direct TAVR patients.…”

Feasibility, safety, and efficacy of transcatheter aortic valve replacement without balloon predilation: A systematic review and meta‐analysis

“…Moreover, the nonrandomized nature of included studies may have introduced bias as the selection of a direct TAVR strategy was left at the operators discretion based on pre‐TAVR evaluation. As demonstrated by Abramowitz et al , it is therefore likely that patients with favorable anatomical characteristics of the aortic valve and arch coupled with a lower calcific burden more often underwent direct TAVR. This is of particular importance as a high correlation between the volume of calcification and the severity of PVL has been previously demonstrated .…”

“…PPI occurs in 10–17% of patients in recent series using both valve types and thus remains a concern given the current shift toward treating lower surgical‐risk patients. Nonetheless, the valve implantation is directly responsible for less than half of new conduction disturbances during TAVR as most of them occur during BPD especially if the balloon is larger than the minor axis of the aortic annulus . This has been described by Lange et al as a two‐hit model, where the first hit is inflicted by a large valvuloplasty balloon to the conduction system promoting the persistence of high‐degree atrioventricular block followed by a second hit by the valve frame.…”

“…These issues are currently evaluated in dedicated randomized trials (The preDIlatation in tRanscathEter aortiC Valve implanTation Trial [DIRECT], NCT02448927; TAVI Without Balloon Predilatation of the Aortic Valve SAPIEN 3 [DIRECTAVI], NCT02729519). Finally, very few data exist regarding moderate BPD which could represent a strategy harboring the theoretical advantages of BPD while limiting its risks.…”

Hot Topics in Transcatheter Aortic Valve Implantation

“…The reduction or elimination of balloon predilation and the reduction in postprocedural length of stay are two of the most debated and studied issues. A few studies have demonstrated the feasibility and effectiveness of TAVI without balloon predilatation [23]. Similarly, early discharge after TAVI in selected patients demonstrated to not preclude the safety of the procedure, as demonstrated in several European and US experiences [20][21][22].…”