Overinflation of balloon‐expandable valves for transcatheter treatment of pure noncalcified native aortic regurgitation: How much oversizing is needed and achievable?

Abstract

Transcatheter aortic valve implantation (TAVI) in noncalcified pure aortic valve regurgitation is challenging as dedicated valves are not widely available. We present a case series of four inoperable patients who underwent compassionate TAVI for this indication at our institution with a balloon-expandable valve. In this context, we analyzed the relevant technical aspects such as the need for larger oversizing of the transcatheter prosthesis and the safety and limits of valve overexpansion.

Case Report: Transcatheter aortic valve implantation using balloon-expandable bioprosthesis in patients with severe pure aortic regurgitation on noncalcified native valves: a series of cases

“…Regarding the implant technique for balloon-expandable valves, the most significant modification concerned oversizing. In the literature, oversizing ranges between 15% and 35% were reported (9). The oversizing used was less than that verified in many case reports or meta-analyses.…”

Simultaneous Transcatheter Aortic and Mitral Native Valve Replacement: A Step-by-Step Procedural Approach

“…Although TAVR for AR is still an off-label indication, there is growing evidence of good procedural results and outcomes, particularly with new-generation valves. 20 Most of the time, achieving approximately 20% 21 , 22 of oversize is critical when using balloon-expandable non–AR-dedicated TAVR valves to pursue good sealing. 23 Several challenges arise during THV deployment for AR: lack of calcifications of aortic annulus and cusps for the anchoring of the prosthesis, absence of fluoroscopic calcific landmarks, increased stroke volume, high back-and-forth flow status through the valve, aortic root dilatations, and annular eccentricity.…”