title: Predictive factors, efficacy, and safety of balloon post-dilation after transcatheter aortic valve implantation with a balloon-expandable valve.
abstract: OBJECTIVE
  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 mm(3) 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.
authors.affiliation: Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Luis
authors.initials: L
authors.lastname: Nombela-Franco
authors.affiliation: Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. Electronic address: josep.rodes@criucpq.ulaval.ca.
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
authors.affiliation: Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: DeLarochellière
authors.affiliation: Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Larose
authors.affiliation: Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Doyle
authors.affiliation: Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Jacques
authors.initials: J
authors.lastname: Villeneuve
authors.affiliation: Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Bergeron
authors.affiliation: Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Bernier
authors.affiliation: Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Ignacio J
authors.initials: IJ
authors.lastname: Amat-Santos
authors.affiliation: Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Mok
authors.affiliation: Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Marina
authors.initials: M
authors.lastname: Urena
authors.affiliation: Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Rheault
authors.affiliation: Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Dumesnil
authors.affiliation: Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Côté
authors.affiliation: Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Pibarot
authors.affiliation: Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Dumont
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000628:therapy*; D002114:Calcinosis / Q000150:complications; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D002404:Catheterization / Q000009:adverse effects; D002561:Cerebrovascular Disorders / Q000209:etiology; D016009:Chi-Square Distribution; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011474:Prosthesis Design; D011792:Quebec; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome