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

Auffret, Vincent; Regueiro, Ander; Campelo‐Parada, Francisco; Trigo, María Del; Chiche, Olivier; Chamandi, Chekrallah; Puri, Rishi; Rodés‐Cabau, Josep

doi:10.1002/ccd.27040

Cited by 39 publications

(36 citation statements)

References 37 publications

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“…A large registry including 5,887 patients 47 demonstrated similar adverse event rates, such as 30-day mortality, stroke, and moderate/severe regurgitation, among patients with and without predilation. These results are consistently in line with previous reports including recent meta-analyses, 49 in addition to longer-term safety data of direct implantation from observational studies. 48 Reduced incidence of permanent pacemaker implantation was also suggested in direct implantation, 50 partially supported by the Brazilian registry, 48 which demonstrated a lower rate of new-onset persistent left bundle branch block in patients with direct implantation.…”

Section: Predilation and Postdilationsupporting

confidence: 93%

“…Direct implantation can lead to reduction of procedure or fluoroscopy time and contrast volume by skipping one procedural step in the treatment flow. 49 However, direct implantation seems to require more frequent postdilation 49 that may theoretically affect prosthesis durability, and is reportedly associated with an increased risk of cerebrovascular events, also detected by diffusion-weighted magnetic resonance imaging, when compared with implantation with predilation. Although not clearly explained in the report, postdilation might be one of the reasons of this finding.…”

Section: Predilation and Postdilationmentioning

confidence: 99%

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Minimalist approach for transcatheter aortic valve replacement

Dallan¹,

Ichibori²,

Attizzani³

2019

J Transcat Intervent

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Transcatheter aortic valve replacement became a routine interventional procedure worldwide, together with improvements in valve technology and optimized implant techniques. The concept of minimalist approach became relevant, aiming at optimal technical implant, fewer perioperative comorbidities, and consequently faster recovery and less associated risks. Compared with surgical aortic valve replacement, reduction of hospital and intensive care unit stay and fewer rates of procedural complications offset the high costs of transcatheter aortic valve replacement valves. The principles of the minimalist approach consist on top performance by experienced structural interventionists, a complete transcatheter basis under local anesthesia and conscious sedation, together with bedside transthoracic echocardiography to access hemodynamic features. It is necessary to customize transcatheter aortic valve replacement optimal procedure by revising how to simplify each aspect of the patient's care process, without losing focus on safety and best outcomes based on individualized patient characteristics, center's expertise, and multidisciplinary care. This review aimed to summarize the current evidence for a minimalist approach to transfemoral transcatheter aortic valve replacement and provide information for its safe and successful implementation and customization.Keywords: Transcatheter aortic valve replacement; Aortic valve/surgery; Aortic valve stenosis; Heart valve prosthesis implantation/methods resumo -O implante transcateter de válvula aórtica tornou-se uma intervenção de rotina em todo o mundo, acompanhando as melhorias na tecnologia das válvulas e a otimização das técnicas de implante. O conceito de abordagem minimalista tornou-se relevante, visando obter um implante tecnicamente ideal, menos comorbidades perioperatórias e, consequentemente, recuperação mais rápida e com menos riscos associados. Em comparação à cirurgia de troca da válvula aórtica, a redução no tempo de hospitalização e na unidade de terapia intensiva, e a menor incidência de complicações do procedimento acabam por compensar os custos mais altos das válvulas para o implante transcateter de válvula aórtica. Os princípios da abordagem minimalista consistem em desempenho superior de intervencionistas estruturais experientes, uma base estrutural completa sob anestesia local e sedação consciente, juntamente da ecocardiografia transtorácica à beira do leito, para avaliar características hemodinâmicas. É necessário customizar um procedimento ideal do implante transcateter de válvula aórtica, procurando simplificar cada um dos aspectos da atenção ao paciente, sem perder o foco na segurança e na obtenção dos melhores desfechos, com base nas características individuais na experiência do centro e no atendimento multidisciplinar. Esta revisão teve como objetivo sintetizar as evidências atuais para uma abordagem minimalista do implante transcateter de válvula aórtica transfemoral, e fornecer informações para garantir a segurança e o sucesso da implementação e customi...

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Section: Predilation and Postdilationsupporting

confidence: 93%

Section: Predilation and Postdilationmentioning

confidence: 99%

Minimalist approach for transcatheter aortic valve replacement

Dallan¹,

Ichibori²,

Attizzani³

2019

J Transcat Intervent

View full text Add to dashboard Cite

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“…However, there is currently a general trend of limiting this technique to avoid complications. Unlike other studies, predilation was not found to be a predictor of the need for PPI . The use of an undersized balloon in the majority of patients may have influenced this finding.…”

Section: Discussioncontrasting

confidence: 82%

Impact of the repositionable Evolut R CoreValve system on the need for a permanent pacemaker after transcatheter aortic valve implantation in patients with severe aortic stenosis

Ojeda

Hidalgo

Romero

et al. 2019

Cathet Cardio Intervent

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Objectives To compare the incidence of permanent pacemaker implantation (PPI) with the CoreValve and Evolut R prostheses, to evaluate the implantation depth with both types of prostheses, and to study factors predicting the need for PPI. Background The Evolut R CoreValve can be recaptured and repositioned during deployment, allowing a more precise implantation. Methods A total of 208 patients treated with CoreValve and 137 patients treated with Evolut R were analyzed. The depth of the prosthesis in the LVOT was measured by angiography in the annular perpendicular view projection after deploymen in all patients. Results Baseline conduction abnormalities were comparable between the groups (85/208, 40.9% vs. 53/137, 38.7%; p = 0.69). The mean prosthesis depth was 10.3 ± 8.6 mm in the CoreValve group and 5.5 ± 2.7 mm in the Evolut R group; p < 0.0001. Conduction disturbances after valve implantation were more frequent with the CoreValve (new‐onset left bundle branch block: 93, 44.7% vs. 16, 11.7%; p < 0.05, first‐degree atrioventricular block: 23, 11.1% vs. 5, 3.6%; p < 0.05). In addition, the incidence of PPI was significantly lower with Evolut R (45, 21.6% vs. 15, 10.9%; p = 0.01). The predictors of the need for PPI were the mean depth of the prosthesis (OR: 1.13, 95% CI: 1.06–1.21; p < 0.0001) and prior right bundle branch block (OR 10.22, 95% CI: 4.62–22.63; p < 0.0001). Conclusions The recapturable capability of the Evolut R system allowed for higher and precise valve implantation. This fact had an impact on the reduction in the need for PPI.

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“…This suggests that BAV may have clinical utility for reducing post‐dilation in individuals with a high degree of leaflet calcification, being largely redundant in those with less calcification. Our findings may go some way toward explaining the discordance between existing studies into the value of BAV in TAVI, some of which associate its omission with an increased need for post‐dilation and others of which present evidence to the contrary . Speculatively, the heterogeneity of calcification and their dependence on HU thresholds between study populations may underlie this disparity, though calcification volume is a largely unreported variable.…”

Section: Discussionmentioning

confidence: 66%

Degree of valve calcification in patients undergoing transfemoral transcatheter aortic valve implantation with and without balloon aortic valvuloplasty: Findings from the multicenter EASE‐IT TF registry

Butter

Okamoto

Schymik

et al. 2019

Cathet Cardio Intervent

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Aims We aimed to assess whether the level of aortic root calcification is associated with BAV performance/omission during transcatheter aortic valve implantation (TAVI), and to explore related outcomes. Methods and results EASE‐IT TF was a prospective, observational, multicenter registry of patients undergoing TF‐TAVI with the Edwards SAPIEN 3, with or without BAV predilation. Valvular calcification was quantified from pre‐procedural multi‐slice computed tomography images and compared between BAV and no BAV patients. Data for 178 patients (55 BAV; 123 no BAV) were analyzed. There were no significant differences between groups in terms of regional/leaflet sector calcification volumes, maximum asymmetry between the different leaflet sectors, or total calcification scores. Overall, a greater‐than‐average leaflet calcification volume was independently predictive of ≥mild PVL (OR: 5.116; 95% CI: 1.042–38.35) and the need for post‐dilation (OR: 3.592; 95% CI: 1.173–12.14). The latter effect was abated in patients with BAV (OR: 1.837; 95% CI: 0.223–18.00) and intensified in those without BAV (OR: 5.575; 95% CI: 1.114–38.74). No other BAV‐dependent effects of calcification on outcomes were observed. Conclusions In the majority of transfemoral valve implantations, calcification does not appear to be the main driving factor in the decision to perform/omit BAV. Predilation may be valuable for reducing post‐dilation requirements in patients only with a greater degree of leaflet calcification.

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

Cited by 39 publications

References 37 publications

Minimalist approach for transcatheter aortic valve replacement

Minimalist approach for transcatheter aortic valve replacement

Impact of the repositionable Evolut R CoreValve system on the need for a permanent pacemaker after transcatheter aortic valve implantation in patients with severe aortic stenosis

Degree of valve calcification in patients undergoing transfemoral transcatheter aortic valve implantation with and without balloon aortic valvuloplasty: Findings from the multicenter EASE‐IT TF registry

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