Preparatory balloon aortic valvuloplasty during transcatheter aortic valve implantation for improved valve sizing.
OBJECTIVE
This study sought to evaluate whether supra-aortic angiography during preparatory balloon aortic valvuloplasty (BAV) improves valve sizing.


BACKGROUND
Current recommendations for valve size selection are based on annular measurements by transesophageal echocardiography and computed tomography, but paravalvular aortic regurgitation (PAR) is a frequent problem.


METHODS
Data of 270 consecutive patients with either conventional sizing (group 1, n = 167) or balloon aortic valvuloplasty-based sizing (group 2, n = 103) were compared. PAR was graded angiographically and quantitatively using several hemodynamic indices.


RESULTS
PAR was observed in 113 patients of group 1 and 41 patients of group 2 (67.7% vs. 39.8%, p < 0.001). More than mild PAR was found in 24 (14.4%) patients of group 1 and 8 (7.8%) patients of group 2. According to pre-interventional imaging, 40 (39%) patients had a borderline annulus size, raising uncertainty regarding valve size selection. Balloon sizing resulted in selection of the bigger prosthesis in 30 (29%) and the smaller prosthesis in the remaining patients, and only 1 of these 40 patients had more than mild PAR. As predicted by the hemodynamic indices of PAR, mortality at 30 days and 1 year was less in group 2 than in group 1 (5.8% vs. 9%, p = 0.2 and 10.6% vs. 20%, p = 0.01).


CONCLUSIONS
Preparatory balloon aortic valvuloplasty during transcatheter aortic valve implantation improves valve size selection, reduces the associated PAR, and increases survival in borderline cases.
Department of Cardiology, West German Heart Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany. Electronic address: polykarpos-christos.patsalis@uk-essen.de.
Polykarpos C
PC
Patsalis
Fadi
F
Al-Rashid
Till
T
Neumann
Björn
B
Plicht
Heike A
HA
Hildebrandt
Daniel
D
Wendt
Matthias
M
Thielmann
Heinz G
HG
Jakob
Gerd
G
Heusch
Raimund
R
Erbel
Philipp
P
Kahlert
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D063126:Balloon Valvuloplasty / Q000009:adverse effects / Q000401:mortality; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
AR index; BAV; DAP; DPTI; DPTI:SPTI; LV; LVEDP; MCV; MSCT; Medtronic CoreValve; PAR; SPTI; TAVI; TEE; aortic regurgitation; aortic regurgitation index; balloon aortic valvuloplasty; balloon valvuloplasty; diastolic aortic pressure; diastolic pressure time integral; left ventricular; left ventricular end-diastolic pressure; multislice computed tomography; paravalvular aortic regurgitation; pressure gradient between DAP and LVEDP; ratio of diastolic over systolic pressure time integral; systolic pressure time integral; transcatheter aortic valve implantation; transesophageal echocardiography; ΔP(DAP–LVEDP)