High-pressure post-dilation following transcatheter valve-in-valve implantation in small surgical valves

EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
Tarun ChakravartyRaj R Makkar

Abstract

Residual gradients >20 mmHg after transcatheter valve-in-valve (ViV) implantation are associated with worse survival. This study aimed to evaluate the feasibility of high-pressure post-dilation with a non-compliant balloon after transcatheter ViV implantation in small surgical valves to optimise haemodynamics. Thirty patients underwent ViV implantation in surgical valves with internal dimension ≤19 mm. High-pressure post-dilation to 16-20 atmospheres with a non-compliant balloon was performed in 12 patients and 18 patients underwent ViV without post-dilation. SAPIEN 3 and Evolut valves were used in 10 and two patients, respectively. The mean aortic valve (AV) gradient decreased by 11.3 mmHg following high-pressure post-dilation (18.7±7.9 mmHg immediately post ViV to 7.5±2.6 mmHg following high-pressure post-dilation, p<0.01). There were no cases of aortic root rupture. High-pressure post-dilation, compared to no post-dilation, was associated with lower invasive AV mean gradients at the end of the ViV procedure (8.2±3.5 mmHg vs. 17.3±7.9 mmHg, p=0.001) as well as lower day 1 (18.0±4.5 mmHg vs. 25.0±8.1 mmHg, p=0.016) and 30-day gradients (19.8±2.5 vs. 26.5±11.0, p=0.038) on transthoracic echocardiography. High-pressure post-dila...Continue Reading

References

Jun 7, 2011·The New England Journal of Medicine·Craig R SmithUNKNOWN PARTNER Trial Investigators
Jun 5, 2013·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Tarun ChakravartyRaj Makkar
Apr 1, 2014·The New England Journal of Medicine·David H AdamsUNKNOWN U.S. CoreValve Clinical Investigators
Jul 10, 2014·JAMA : the Journal of the American Medical Association·Danny DvirUNKNOWN Valve-in-Valve International Data Registry Investigators
Jul 26, 2015·Circulation. Cardiovascular Interventions·Jens Erik Nielsen-KudskHenning Rud Andersen
Jan 8, 2016·JACC. Cardiovascular Interventions·Anupama ShivarajuAlbert M Kasel

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Citations

Jul 10, 2018·Journal of the American Heart Association·Anupama ShivarajuAlbert M Kasel
Oct 1, 2019·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Janarthanan SathananthanJohn Webb
Oct 26, 2018·Circulation. Cardiovascular Interventions·Leonardo de Freitas Campos GuimarãesJosep Rodés-Cabau
Feb 14, 2021·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Abhishek ThandraVenkata M Alla

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