Post-dilation in transcatheter aortic valve replacement: A systematic review and meta-analysis.
OBJECTIVE
The aim of this study was to perform a meta-analysis to compare the outcomes of patients undergoing TAVR with and without balloon post-dilation (PD).


BACKGROUND
PD is a commonly used technique in TAVR to minimize paravalvular regurgitation (PVR), albeit supported by little evidence.


METHODS
Systematic review and meta-analysis of 6 studies comparing 889 patients who had PD compared to 4118 patients without PD.


RESULTS
Patients undergoing PD were more likely male (OR 1.92; 95% CI, 1.41-2.61; P < 0.001) and to have coronary artery disease (OR 1.31; 95% CI, 1.03-1.68; P = 0.03) than those patients not requiring PD. There were no significant differences in 30-day mortality (OR 1.24; 95% CI, 0.88-1.74; P = 0.22) and myocardial infarction (OR 0.93; 95% CI, 0.46-1.90; P = 0.85). Patients undergoing TAVR did not have higher 1-year mortality rates (OR 0.98; 95% CI, 0.61-1.56; P = 0.92). The incidence of stroke was significantly greater in patients with PD (OR, 1.71; 95% CI, 1.10-2.66). PD was able to reduce the incidence of moderate-severe PVR by 15 fold (OR 15.0; 95% CI, 4.2-54.5; P < 0.001), although rates of moderate-severe PVR were still higher after PD than patients who did not require PD (OR 3.64; 95% CI, 1.96-6.75; P < 0.001).


CONCLUSIONS
PD significantly improves rates of PVR, however careful patient selection is needed to minimize increased risk of strokes.
University of Sydney, Sydney, New South Wales, Australia.|Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
Nelson
http://orcid.org/0000-0002-8197-5090
N
Wang
University of Sydney, Sydney, New South Wales, Australia.|Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
Sean
S
Lal
D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000601:surgery*; D063126:Balloon Valvuloplasty / Q000009:adverse effects / Q000379:methods; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006801:Humans; D015994:Incidence; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods
TAVR; aortic stenosis; paravalvular regurgitation; post-dilation