title: Balloon post-dilation and valve-in-valve implantation for the reduction of paravalvular leakage with use of the self-expanding CoreValve prosthesis.
abstract: OBJECTIVE
  The aims of the study were to evaluate balloon post-dilation (BPD) and valve-in-valve (ViV) implantation for the reduction of paravalvular leakage (PVL) in patients undergoing transcatheter aortic valve implantation (TAVI) with use of the self-expanding CoreValve prosthesis and to assess whether the aortic regurgitation (AR) index can be used to quantify the reduction of PVL by these corrective measures.
  
  
  RESULTS
  Angiography and the AR index were used to evaluate the severity of PVL before and after corrective measures in patients suffering from more than mild PVL. Corrective measures were performed in 44.7% (101/226 patients): BPD was performed in 85 patients and ViV implantation in 16 patients, respectively. In 86% (87/101 patients), PVL reduction was successful (no or mild PVL). BPD increased the AR index from 19.1±11.0 to 25.9±5.8 (p<0.001) and ViV implantation from 17.6±6.4 to 29.5±9.1 (p=0.008). One-year mortality (21.6% vs. 17.6% vs. 25.0%; p=0.69) and procedural stroke rate (2.4% vs. 2.4% vs. 0%; p=0.82) were not different between patients without corrective measures compared to patients who had undergone corrective measures (BPD or ViV).
  
  
  CONCLUSIONS
  BPD and ViV implantation are safe and effective to reduce PVL in TAVI patients. The AR index is useful to quantify the success of these corrective measures for PVL reduction objectively.
authors.affiliation: Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Stundl
authors.forename: Marie-Caroline
authors.initials: MC
authors.lastname: Rademacher
authors.forename: Claire
authors.initials: C
authors.lastname: Descoups
authors.forename: Marcel
authors.initials: M
authors.lastname: Weber
authors.forename: Alexander
authors.initials: A
authors.lastname: Sedaghat
authors.forename: Matthias
authors.initials: M
authors.lastname: Grube
authors.forename: Christoph
authors.initials: C
authors.lastname: Hammerstingl
authors.forename: Fritz
authors.initials: F
authors.lastname: Mellert
authors.forename: Mariuca
authors.initials: M
authors.lastname: Vasa-Nicotera
authors.forename: Armin
authors.initials: A
authors.lastname: Welz
authors.forename: Eberhard
authors.initials: E
authors.lastname: Grube
authors.forename: Nikos
authors.initials: N
authors.lastname: Werner
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.forename: Jan-Malte
authors.initials: JM
authors.lastname: Sinning
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000401:mortality; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods / Q000401:mortality; D016896:Treatment Outcome