Does simultaneous aortography and balloon aortic valvuloplasty before TAVR affect prosthesis selection and procedural outcomes in patients with severe aortic valve stenosis?
Simultaneous aortography and balloon valvuloplasty before TAVR is a feasible adjunct to non-invasive imaging that can optimize prosthesis size selection.
AIMS: To describe a technique of simultaneous aortography and balloon aortic valvuloplasty (BAV) before transcatheter aortic valve replacement (TAVR), and to show how this technique affected TAVR prosthesis selection and procedural outcomes. METHODS AND RESULTS: One hundred and eleven patients underwent simultaneous contrast injection during valvuloplasty pre-TAVR to confirm the indication for prosthesis size provided by non-invasive imaging studies. A successful injection was achieved in 95 patients (85.5%). No events occurred during simultaneous BAV and contrast injection. In 12 (10.8%) patients the prosthesis size implanted was different from the recommendations provided by the non-invasive imaging examinations. In nine of these cases (75.0%) it was decided to implant a larger prosthesis than that originally suggested, in the remaining three cases (25.0%) a smaller valve was implanted. Device success in this particular subset of patients was 100%. Overall device success was 92.8%. Post-procedural moderate paravalvular regurgitation was reported in 5.4% of patients. CONCLUSIONS: In patients with severe aortic valve stenosis, a technique of simultaneous aortography and balloon valvuloplasty as an adjunct to non-invasive imaging modalities for transcatheter prosthesis selection is feasible, and leads to a change in TAVR strategy in a modest number of patients. Larger studies are necessary to confirm these findings, and to assess whether this method is capable of enhancing the safety of the TAVR procedure.
Barbanti et al. (2014) studied this question.