title: Transcatheter Aortic Valve Implantation With or Without Preimplantation Balloon Aortic Valvuloplasty: A Systematic Review and Meta-Analysis.
abstract: Preimplantation balloon aortic valvuloplasty (BAV) is considered a routine procedure during transcatheter aortic valve implantation (TAVI) to facilitate prosthesis implantation and expansion; however, it has been speculated that fewer embolic events and/or less hemodynamic instability may occur if TAVI is performed without preimplantation BAV. The aim of this study was to systematically review the clinical outcomes associated with TAVI undertaken without preimplantation BAV.
  
  
  
  We conducted a search of Medline and Embase to identify studies that evaluated patients who underwent TAVI with or without preimplantation BAV for predilation. Pooled analysis and random-effects meta-analyses were used to estimate the rate and risk of adverse outcomes. Sixteen studies involving 1395 patients (674 with and 721 without preimplantation BAV) fulfilled the inclusion criteria. Crude device success was achieved in 94% (1311 of 1395), and 30-day all-cause mortality occurred in 6% (72 of 1282) of patients. Meta-analyses evaluating outcomes of strategies with and without preimplantation BAV showed no statistically significant differences in terms of mortality (relative risk [RR] 0.61, 95% CI 0.32-1.14, P=0.12), safety composite end point (RR 0.85, 95% CI 0.62-1.18, P=0.34), moderate to severe paravalvular leaks (RR 0.68, 95% CI 0.23-1.99, P=0.48), need for postdilation (RR 0.86, 95% CI 0.66-1.13, P=0.58), stroke and/or transient ischemic attack (RR 0.72, 95% CI 0.30-1.71, P=0.45), and permanent pacemaker implantation (RR 0.80, 95% CI 0.49-1.30, P=0.37).
  
  
  
  Our analysis suggests that TAVI procedures with or without preimplantation BAV were associated with similar outcomes for a number of clinically relevant end points. Further studies including a large number of patients are needed to ascertain the impact of TAVI without preimplantation BAV as a standard practice.
authors.affiliation: Division of Cardiology, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada rodrigo.bagur@lhsc.on.ca.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Bagur
authors.affiliation: Royal Stoke University Hospital, Stoke-on-Trent, Staffordshire, United Kingdom Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Primary Care, Keele University, Stoke-on-Trent, Staffordshire, United Kingdom.
authors.forename: Chun Shing
authors.initials: CS
authors.lastname: Kwok
authors.affiliation: Division of Cardiology, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Nombela-Franco
authors.affiliation: Queen Elizabeth Hospital, Birmingham, United Kingdom.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Ludman
authors.affiliation: James Cook University Hospital, Middlesbrough, North Yorkshire, United Kingdom.
authors.forename: Mark A
authors.initials: MA
authors.lastname: de Belder
authors.affiliation: Cardiothoracic Department, University Hospital of Udine, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Sponga
authors.affiliation: Royal Stoke University Hospital, Stoke-on-Trent, Staffordshire, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Gunning
authors.affiliation: Royal Stoke University Hospital, Stoke-on-Trent, Staffordshire, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Nolan
authors.affiliation: Division of Cardiology, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada.
authors.forename: Pantelis
authors.initials: P
authors.lastname: Diamantouros
authors.affiliation: Division of Cardiology, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Teefy
authors.affiliation: Department of Surgery, Western University, London, Ontario, Canada Division of Cardiac Surgery, London Health Sciences Centre, University Hospital, London, Ontario, Canada.
authors.forename: Bob
authors.initials: B
authors.lastname: Kiaii
authors.affiliation: Department of Surgery, Western University, London, Ontario, Canada Division of Cardiac Surgery, London Health Sciences Centre, University Hospital, London, Ontario, Canada.
authors.forename: Michael W A
authors.initials: MW
authors.lastname: Chu
authors.affiliation: Royal Stoke University Hospital, Stoke-on-Trent, Staffordshire, United Kingdom Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Primary Care, Keele University, Stoke-on-Trent, Staffordshire, United Kingdom.
authors.forename: Mamas A
authors.initials: MA
authors.lastname: Mamas
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D063126:Balloon Valvuloplasty / Q000379:methods* / Q000401:mortality; D004812:Epidemiologic Methods; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome
keywords: aortic stenosis; aortic valve replacement; balloon aortic valvuloplasty; transcutaneous aortic valve implantation; transfemoral aortic valve implantation