Impact of balloon post-dilation on clinical outcomes after transcatheter aortic valve replacement with the self-expanding CoreValve prosthesis

Marco Barbanti, Anna Sonia Petronio, Davide Capodanno, Federica Ettori, Antonio Colombo, Francesco Bedogni, Federico De Marco, Marco De Carlo, Claudia Fiorina, Azeem Latib, Luca Testa, Giuseppe Bruschi, Arnaldo Poli, Cristina Giannini, Salvatore Curello, Diego Maffeo, Carmelo Sgroi, Paola Martina, Simona Gulino, Martina PatanèYohei Ohno, Guilherme F. Attizzani, Sebastiano Immè, Stefano Cannata, Alessandra Gentili, Agnese Rossi, Corrado Tamburino

Research output: Contribution to journalArticlepeer-review

32 Scopus citations

Abstract

Objectives The aim of this study was to assess the incidence and clinical impact of balloon post-dilation (BPD) after transcatheter aortic valve replacement (TAVR) with the CoreValve prosthesis (Medtronic Inc., Minneapolis, Minnesota).

Background BPD is a widely adopted strategy to reduce the degree of paraprosthetic regurgitation in case of transcatheter heart valve underexpansion. However, controversies still remain regarding its real effectiveness and safety.

Methods The ClinicalService (a nation-based data repository and medical care project) dataset was analyzed. All patients were dichotomized according to the need for BPD during the index procedure.

Results Among 1,376 patients, BPD of the transcatheter heart valve was performed in 272 (19.8%). In 37% of cases, it was unsuccessful at reducing the paravalvular regurgitation to mild or less. No case of valve embolization, new intravalvular regurgitation, coronary occlusion, and aortic root injury occurred during BPD. There were no statistically significant differences between the 2 groups in the incidence of in-hospital all-cause and cardiovascular mortality, neurological events, myocardial infarction, bleeding, conversion to open-chest surgery, and the need for a permanent pacemaker. The need for BPD did not emerge as an independent risk factor for all-cause (adjusted hazard ratio [HR]: 1.33, 95% confidence interval [CI]: 0.81 to 2.19, p = 0.264) and cardiovascular (adjusted HR: 1.48, 95% CI: 0.74 to 2.97, p = 0.265) mortality at 1 year after the procedure. In addition, BPD did not predispose to higher odds of neurological events during 12 months after TAVR (HR: 0.92, 95% CI: 0.45 to 1.88, p = 0.815).

Conclusions This large study showed that BPD after TAVR was safe and not associated with increased rates of cerebrovascular events, mortality, myocardial infarction, and aortic root injury.

Original languageEnglish (US)
Pages (from-to)1014-1021
Number of pages8
JournalJACC: Cardiovascular Interventions
Volume7
Issue number9
DOIs
StatePublished - Sep 1 2014
Externally publishedYes

Keywords

  • TAVR
  • post-dilation
  • underexpansion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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