Author + information
- Received November 7, 2011
- Revision received January 9, 2012
- Accepted February 4, 2012
- Published online May 1, 2012.
- Luis Nombela-Franco, MD,
- Josep Rodés-Cabau, MD⁎ (, )
- Robert DeLarochellière, MD,
- Eric Larose, MD,
- Daniel Doyle, MD,
- Jacques Villeneuve, MD,
- Sébastien Bergeron, MD,
- Mathieu Bernier, MD,
- Ignacio J. Amat-Santos, MD,
- Michael Mok, MD,
- Marina Urena, MD,
- Michel Rheault, MD,
- Jean Dumesnil, MD,
- Mélanie Côté, MSc,
- Philippe Pibarot, PhD and
- Eric Dumont, MD
- ↵⁎Reprint requests and correspondence:
Dr. Josep Rodés-Cabau, Department of Cardiology, Quebec Heart and Lung Institute, 2725 Chemin Suite-Foy, Quebec City, Quebec G1V 4G5, Canada
Objectives This study sought to evaluate the predictive factors, effects, and safety of balloon post-dilation (BPD) for the treatment of significant paravalvular aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI).
Background Very few data exist on BPD after TAVI with a balloon-expandable valve.
Methods A total of 211 patients who underwent TAVI with a balloon-expandable valve were included. BPD was performed after TAVI if paravalvular AR ≥2 was identified by transesophageal echocardiography. Clinical events and echocardiographic data were prospectively recorded, and median follow-up was 12 (6 to 24) months.
Results BPD was performed in 59 patients (28%), leading to a reduction in at least 1 degree of AR in 71% of patients, with residual AR <2 in 54% of the patients. The predictors of the need for BPD were the degree of valve calcification and transfemoral approach, with valve calcification volume >2,200 and >3,800 mm3 best determining the need for and a poor response to BPD, respectively. Patients who underwent BPD had a higher incidence of cerebrovascular events at 30 days (11.9% vs. 2.0%, p = 0.006), with most (83%) events within the 24 h after the procedure occurring in patients who had BPD. No significant changes in valve area or AR degree were observed at follow-up in BPD and no-BPD groups.
Conclusions BPD was needed in about one-fourth of the patients undergoing TAVI with a balloon-expandable valve and was successful in about one-half of them. A higher degree of valve calcification and transfemoral approach predicted the need for BPD. BPD was not associated with any deleterious effect on valve function at mid-term follow-up, but a higher rate of cerebrovascular events was observed in patients who had BPD.
- balloon post-dilation
- transcatheter aortic valve implantation
- transcatheter aortic valve replacement
Dr. Nombela-Franco received funding via a research grant from the Fundación Alfonso Martín Escudero (Spain). Dr. Rodés-Cabau is a consultant for Edwards Lifesciences, Inc. and St. Jude Medical. Dr. DeLarochellière is a consultant for St. Jude Medical. Dr. Urena received a grant from the Sociedad Española de Cardiologia. Dr. Dumont is a consultant for Edwards Lifesciences, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 7, 2011.
- Revision received January 9, 2012.
- Accepted February 4, 2012.
- 2012 American College of Cardiology Foundation