Key result
Balloon post-dilation and valve-in-valve implantation reduced paravalvular leakage in 86% of TAVI patients, with 1-year mortality (17.6% and 25.0%) similar to no corrective measures (21.6%; P=0.69).
Why the study?
Does balloon post-dilation or valve-in-valve implantation reduce paravalvular leakage in patients undergoing TAVI with a self-expanding CoreValve prosthesis?
Cohort (n=226)
Does balloon post-dilation or valve-in-valve implantation reduce paravalvular leakage in patients undergoing TAVI with a self-expanding CoreValve prosthesis?
p-value: p=0.69
Balloon post-dilation and valve-in-valve implantation are effective strategies to reduce paravalvular leakage after TAVI, and the AR index is a useful objective measure of this reduction.
Post-dilation or valve-in-valve for paravalvular leak after TAVI was not associated with lower mortality; leaves open whether selective use improves outcomes.
AIMS: The aims of the study were to evaluate balloon post-dilation (BPD) and valve-in-valve (ViV) implantation for the reduction of paravalvular leakage (PVL) in patients undergoing transcatheter aortic valve implantation (TAVI) with use of the self-expanding CoreValve prosthesis and to assess whether the aortic regurgitation (AR) index can be used to quantify the reduction of PVL by these corrective measures. METHODS AND RESULTS: Angiography and the AR index were used to evaluate the severity of PVL before and after corrective measures in patients suffering from more than mild PVL. Corrective measures were performed in 44.7% (101/226 patients): BPD was performed in 85 patients and ViV implantation in 16 patients, respectively. In 86% (87/101 patients), PVL reduction was successful (no or mild PVL). BPD increased the AR index from 19.1±11.0 to 25.9±5.8 (p<0.001) and ViV implantation from 17.6±6.4 to 29.5±9.1 (p=0.008). One-year mortality (21.6% vs. 17.6% vs. 25.0%; p=0.69) and procedural stroke rate (2.4% vs. 2.4% vs. 0%; p=0.82) were not different between patients without corrective measures compared to patients who had undergone corrective measures (BPD or ViV). CONCLUSIONS: BPD and ViV implantation are safe and effective to reduce PVL in TAVI patients. The AR index is useful to quantify the success of these corrective measures for PVL reduction objectively.
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Stundl et al. (2016) conducted a cohort in Paravalvular leakage after transcatheter aortic valve implantation (n=226). Balloon post-dilation and valve-in-valve implantation vs. No corrective measures was evaluated on 1-year mortality (p=0.69). Balloon post-dilation and valve-in-valve implantation reduced paravalvular leakage in 86% of TAVI patients, with 1-year mortality (17.6% and 25.0%) similar to no corrective measures (21.6%; P=0.69).
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