title: Usefulness of echocardiographic criteria for transcatheter aortic valve implantation without balloon predilation: a single-center experience.
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) is an alternative therapy for high-risk patients with symptomatic aortic stenosis. TAVI without balloon aortic predilation (BPD) has been found to be as feasible and safe as the standard approach with predilation. The aim of this study was to show the usefulness of transesophageal echocardiographic (TEE) criteria during patient selection for TAVI without BPD and compare the results with those from a control group.
  
  
  METHODS
  Two hundred forty-nine consecutive patients with severe symptomatic aortic stenosis underwent echocardiographic evaluation before TAVI. Two-dimensional and three-dimensional TEE imaging was used to evaluate the aortic annulus and root, leaflet mobility and degree of calcification, orifice characteristics, valve area, and aortic regurgitation. After TEE data were reviewed, patients were considered to be favorable candidates, or not, for TAVI without BPD on the basis of specific echocardiographic criteria.
  
  
  RESULTS
  The mean age was 82 ± 5 years. Seventy-nine patients underwent TAVI without BPD, and 170 patients underwent TAVI with BPD. The mean aortic valve area was 0.61 ± 0.16 cm(2), and the mean aortic annular diameter was 2.2 ± 0.25 cm. In the group without BPD, Edwards SAPIEN XT valves were implanted in 64.6% (n = 51) and Medtronic CoreValve prostheses in 35.4% (n = 28). In this group, residual paravalvular aortic regurgitation immediately after valve deployment was seen in 53.2% of patients, without differences from those who underwent TAVI with BPD. Permanent pacemaker implantation was less frequent in the group of patients without BPD (6.3% vs 14.1%, P = .030). Procedure-related mortality was significantly lower in patients without BPD (2.5% vs 11.8%, P = .018).
  
  
  CONCLUSIONS
  Thorough TEE assessment of aortic valve features permits the selection of patients with ideal conditions for TAVI without BPD, regardless of the type of prosthesis. Using the echocardiographic criteria described here, it is possible to achieve a good rate of procedural success with a low complication rate in patients undergoing TAVI without BPD.
authors: Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain. Electronic address: fabianislas@gmail.com.
authors: Fabián
authors: F
authors: Islas
authors: Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain.
authors: Carlos
authors: C
authors: Almería
authors: Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain.
authors: Eulogio
authors: E
authors: García-Fernández
authors: Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain.
authors: Pilar
authors: P
authors: Jiménez
authors: Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain.
authors: Luis
authors: L
authors: Nombela-Franco
authors: Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain.
authors: Carmen
authors: C
authors: Olmos
authors: Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain.
authors: Pedro
authors: P
authors: Marcos-Alberca
authors: Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain.
authors: Ana
authors: A
authors: Cuadrado
authors: Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain.
authors: Antonio
authors: A
authors: Fernández-Ortiz
authors: Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain.
authors: Carlos
authors: C
authors: Macaya
authors: Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain.
authors: Leopoldo
authors: L
authors: Pérez de Isla
mesh_terms: D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D018579:Patient Selection; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
keywords: 3D echocardiography; Balloon predilation; TAVI