TCT-743 To Predilate or To Not Predilate In Transcatheter Aortic Valve Implantation? Single-Center Experience With Self-Expandable CoreValve Revalving System

Giustino, Gennaro; Montorfano, Matteo; Latib, Azeem; Panoulas, Vasileios F.; Chieffo, Alaide; Spatuzza, Paola; Ferré, Georgina Fuertes; Agricola, Eustachio; Spagnolo, Pietro; Covello, Remo Daniel; Alfieri, Ottavio; Colombo, Antonio

doi:10.1016/j.jacc.2014.07.815

Cited by 5 publications

(16 citation statements)

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“…Notably, our results show more cardiac tamponade without BAV, although one may be cautious in interpreting results based on only 2 studies . Forceful pushing of the device and movement of the stiff wire inside the ventricle might cause this issue.…”

Section: Discussionmentioning

confidence: 61%

“…The safety composite end point was reported in 6 studies and occurred in 21% (111 of 537) of patients. The crude incidence of residual moderate or severe aortic regurgitation or PVL was reported in 9 studies and occurred in 16% (124 of 757) of patients. In this regard, 4 studies used the balloon‐expandable valve with a 3% rate (9 of 262 patients), and 5 studies used the self‐expandable valve with a 23% rate (115 of 495 patients).…”

Section: Resultsmentioning

confidence: 99%

“…The crude incidence of residual moderate or severe aortic regurgitation or PVL was reported in 9 studies and occurred in 16% (124 of 757) of patients. In this regard, 4 studies used the balloon‐expandable valve with a 3% rate (9 of 262 patients), and 5 studies used the self‐expandable valve with a 23% rate (115 of 495 patients). Of note, the need for postimplantation postdilation was reported in 14 studies and occurred in 18% (210 of 1177) of patients; 9 studies used the balloon‐expandable valve with a 14% rate (118 of 864 patients), and 6 studies used the self‐expandable valve with a 29% rate (92 of 313 patients).…”

Section: Resultsmentioning

confidence: 99%

“…In this regard, 4 studies used the balloon‐expandable valve with a 3% rate (9 of 262 patients), and 5 studies used the self‐expandable valve with a 23% rate (115 of 495 patients). Of note, the need for postimplantation postdilation was reported in 14 studies and occurred in 18% (210 of 1177) of patients; 9 studies used the balloon‐expandable valve with a 14% rate (118 of 864 patients), and 6 studies used the self‐expandable valve with a 29% rate (92 of 313 patients). The crude cerebrovascular events, including stroke or transient ischemic attack, were reported in 12 studies and occurred in 3% (28/1014) of patients; 7 studies used the balloon‐expandable valve with a 3% rate (24 of 701 patients), and 5 studies used the self‐expandable valve with a 1% rate (4 of 313 patients).…”

Section: Resultsmentioning

confidence: 99%

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Transcatheter Aortic Valve Implantation With or Without Preimplantation Balloon Aortic Valvuloplasty: A Systematic Review and Meta‐Analysis

Bagur

Kwok

Nombela‐Franco

et al. 2016

JAHA

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BackgroundPreimplantation balloon aortic valvuloplasty (BAV) is considered a routine procedure during transcatheter aortic valve implantation (TAVI) to facilitate prosthesis implantation and expansion; however, it has been speculated that fewer embolic events and/or less hemodynamic instability may occur if TAVI is performed without preimplantation BAV. The aim of this study was to systematically review the clinical outcomes associated with TAVI undertaken without preimplantation BAV.Methods and ResultsWe conducted a search of Medline and Embase to identify studies that evaluated patients who underwent TAVI with or without preimplantation BAV for predilation. Pooled analysis and random‐effects meta‐analyses were used to estimate the rate and risk of adverse outcomes. Sixteen studies involving 1395 patients (674 with and 721 without preimplantation BAV) fulfilled the inclusion criteria. Crude device success was achieved in 94% (1311 of 1395), and 30‐day all‐cause mortality occurred in 6% (72 of 1282) of patients. Meta‐analyses evaluating outcomes of strategies with and without preimplantation BAV showed no statistically significant differences in terms of mortality (relative risk [RR] 0.61, 95% CI 0.32–1.14, P=0.12), safety composite end point (RR 0.85, 95% CI 0.62–1.18, P=0.34), moderate to severe paravalvular leaks (RR 0.68, 95% CI 0.23–1.99, P=0.48), need for postdilation (RR 0.86, 95% CI 0.66–1.13, P=0.58), stroke and/or transient ischemic attack (RR 0.72, 95% CI 0.30–1.71, P=0.45), and permanent pacemaker implantation (RR 0.80, 95% CI 0.49–1.30, P=0.37).ConclusionsOur analysis suggests that TAVI procedures with or without preimplantation BAV were associated with similar outcomes for a number of clinically relevant end points. Further studies including a large number of patients are needed to ascertain the impact of TAVI without preimplantation BAV as a standard practice.

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Section: Discussionmentioning

confidence: 61%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Transcatheter Aortic Valve Implantation With or Without Preimplantation Balloon Aortic Valvuloplasty: A Systematic Review and Meta‐Analysis

Bagur

Kwok

Nombela‐Franco

et al. 2016

JAHA

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“…Nonetheless, the feasibility of conducting TAVI without BAV in CoreValve patients was first proposed in a pilot study of 60 patients . Subsequent studies have shown that clinical outcomes are similar between BAV treatment groups in CoreValve patients . Theoretically, conducting TAVI without BAV in self‐expanding valves could potentially lead to worse outcomes.…”

Section: Discussionmentioning

confidence: 99%

Pre‐Implantation Balloon Aortic Valvuloplasty and Clinical Outcomes Following Transcatheter Aortic Valve Implantation: A Propensity Score Analysis of the UK Registry

Martin

Sperrin

Bagur

et al. 2017

JAHA

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BackgroundAortic valve predilation with balloon aortic valvuloplasty (BAV) is recommended before transcatheter aortic valve implantation (TAVI), despite limited data around the requirement of this preprocedural step and the potential risks of embolization. This study aimed to investigate the trends in practice and associations of BAV on short‐term outcomes in the UK TAVI registry.Methods and ResultsEleven clinical endpoints were investigated, including 30‐day mortality, myocardial infarction, aortic regurgitation, valve dysfunction, and composite early safety. All endpoints were defined as per the VARC‐2 definitions. Odd ratios of each endpoint were estimated using logistic regression, with data analyzed in balloon‐ and self‐expandable valve subgroups. Propensity scores were calculated using patient demographics and procedural variables, which were included in the models of each endpoint to adjust for measured confounding. Between 2007 and 2014, 5887 patients met the study inclusion criteria, 1421 (24.1%) of whom had no BAV before TAVI valve deployment. We observed heterogeneity in the use of BAV nationally, both temporally and by center experience; rates of BAV in pre‐TAVI workup varied between 30% and 97% across TAVI centers. All endpoints were similar between treatment groups in SAPIEN (Edwards Lifesciences Inc., Irvine, CA) valve patients. After correction for multiple testing, none of the endpoints in CoreValve (Medtronic, Minneapolis, MN) patients were significantly different between patients with or without predilation.ConclusionsPerforming TAVI without predilation was not associated with adverse short‐term outcomes post procedure, especially when using a balloon‐expandable prosthesis. Randomized trials including different valve types are required to provide conclusive evidence regarding the utility of predilation before‐TAVI.

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Balloon Aortic Valvuloplasty

Ferreira¹,

Braghiroli²,

Mendoza³

2023

Mastering Structural Heart Disease

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TCT-743 To Predilate or To Not Predilate In Transcatheter Aortic Valve Implantation? Single-Center Experience With Self-Expandable CoreValve Revalving System

Cited by 5 publications

References 0 publications

Transcatheter Aortic Valve Implantation With or Without Preimplantation Balloon Aortic Valvuloplasty: A Systematic Review and Meta‐Analysis

Transcatheter Aortic Valve Implantation With or Without Preimplantation Balloon Aortic Valvuloplasty: A Systematic Review and Meta‐Analysis

Pre‐Implantation Balloon Aortic Valvuloplasty and Clinical Outcomes Following Transcatheter Aortic Valve Implantation: A Propensity Score Analysis of the UK Registry

Balloon Aortic Valvuloplasty

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