Efficacy and Safety of Postdilatation to Reduce Paravalvular Regurgitation During Balloon-Expandable Transcatheter Aortic Valve Replacement
Why the study?
Does postdilatation reduce paravalvular regurgitation in patients undergoing balloon-expandable TAVR?
Population
259 consecutive patients undergoing balloon-expandable transcatheter aortic valve replacement (TAVR)
Comparison
Postdilatation (PD) after balloon-expandable TAVR vs No postdilatation
Design
Cohort
Authors
Discussion
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Member takes
Implication
Supports consideration of postdilatation for greater-than-mild PVR after balloon-expandable TAVR; leaves open confirmation in randomized trials.
Key Points
- To evaluate the safety and efficacy of postdilatation to reduce paravalvular regurgitation after balloon-expandable TAVR.
- Reviewed consecutive cases of TAVR for clinical outcomes and transesophageal echocardiography imaging.
- Measured PVR areas after valve deployment, postdilatation, and at study completion.
- Compared stent dimensions pre- and post-postdilatation using angiography.
- PD patients had significantly larger PVR areas immediately after deployment (40.3 mm² vs 15.4 mm²; P<0.0001).
- Postdilatation resulted in significant reduction in PVR area (21.7 mm²; P<0.0001).
- PD increased stent dimensions; no significant differences in major aortic injury or pacemaker rates.
Structured PICO
Does postdilatation reduce paravalvular regurgitation in patients undergoing balloon-expandable TAVR?
P
Population
259 consecutive patients undergoing balloon-expandable transcatheter aortic valve replacement (TAVR)
I
Intervention
Postdilatation (PD) after balloon-expandable TAVR
C
Comparator
No postdilatation
O
Outcome
Paravalvular regurgitation (PVR) area reduction and safety outcomes (cerebrovascular events, major aortic injury, permanent pacemaker implantation)surrogate
Postdilatation is effective at reducing paravalvular regurgitation in patients with greater than mild PVR after balloon-expandable TAVR without significantly increasing major aortic injury or pacemaker rates.
Cite This Study
Daneault et al. (2013) studied this question.