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December 18, 2018Structural HeartOpen Access

Balloon predilation in TAVR was associated with a lower need for postdilation (30.2% vs 39.0%) but higher permanent pacemaker implantation (25.1% vs 15.6%; aOR 3.086) compared to no predilation.

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Why the study?

The utility of routine balloon predilation in TAVR with self-expanding valves is not established, and clinical outcomes at 30 days and 1 year with a no balloon predilation strategy have not been systematically described.

Does routine balloon predilation improve procedural and clinical outcomes in patients undergoing TAVR with self-expanding valves?

Population

564 patients who underwent TAVR with self-expanding valves

Comparison

Predilation vs no predilation

Design

Observational cohort study

Follow-up

1 year

Key result

Balloon predilation in TAVR was associated with a lower need for postdilation (30.2% vs 39.0%) but higher permanent pacemaker implantation (25.1% vs 15.6%; aOR 3.086) compared to no predilation.

Authors

HRHasan RehmanAKAnkur KalraJCJohn Cochran

Discussion

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Member takes

Overview

Predilation may raise pacemaker risk without PVL benefit; leaves open whether routine use improves self-expanding TAVR outcomes.

Study Design

Type

Cohort (n=564)

Structured PICO

Does routine balloon predilation improve procedural and clinical outcomes in patients undergoing TAVR with self-expanding valves?

P
Population
564 patients who underwent TAVR with self-expanding valves between 2011 and 2016, stratified by balloon predilation strategy.
E
Exposure
Routine balloon predilation prior to TAVR
C
Comparator
No balloon predilation prior to TAVR
O
Outcome
Clinical and procedural outcomes at 30 days and 1 year post TAVR, including need for postdilation, paravalvular leak, permanent pacemaker implantation, myocardial infarction, stroke, and death

Main Result

Odds Ratio: 0.741 (95% CI 0.493–1.114)

Absolute Event Rate: 30.2% vs 39%

Balloon predilation during TAVR with self-expanding valves is associated with an increased risk of permanent pacemaker implantation without significant differences in paravalvular leak, stroke, or death.

Cite This Study

Rehman et al. (2018) conducted a cohort in Transcatheter aortic valve replacement (TAVR) (n=564). Balloon predilation vs. No predilation was evaluated on Need for postdilation (aOR 0.741, 95% CI 0.493-1.114). Balloon predilation in TAVR was associated with a lower need for postdilation (30.2% vs 39.0%) but higher permanent pacemaker implantation (25.1% vs 15.6%; aOR 3.086) compared to no predilation.

synapsesocial.com/papers/6a6aba7026cff2e2f6f42865https://doi.org/10.1080/24748706.2018.1549763
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Omission of predilation in balloon-expandable transcatheter aortic valve implantation: retrospective analysis in a large-volume centre2017 · 9 citations
  2. 2Pre‐Implantation Balloon Aortic Valvuloplasty and Clinical Outcomes Following Transcatheter Aortic Valve Implantation: A Propensity Score Analysis of the UK Registry2017 · 51 citations
  3. 3Pre-dilation and Post-dilation in Transcatheter Aortic Valve Replacement: Indications, Benefits and Risks2021 · 35 citations
  4. 4Balloon Aortic Valvuloplasty Prior to Self‐Expanding TAVI: The BAVSE‐TAVI Registry2025 · 3 citations
  5. 5Transcatheter aortic valve implantation without balloon predilatation2012 · 24 citations