Intraprocedural balloon dilation of the direct flow medical transcatheter aortic valve: First United States experience

Optimization of hemodynamics during transcatheter aortic valve replacement (TAVR) using the commercially available balloon expandable and self-expanding valves is often accomplished through post-dilation of the valves' metallic frame. The direct flow medical (DFM) valve is a uniquely designed second-generation TAVR prosthetic without a rigid metallic frame. It is not widely known whether balloon dilation of this valve is beneficial when valve hemodynamics after initial deployment suboptimal due to valve underexpansion. We present the first two US patients who underwent TAVR using the DFM valve who had underexpansion in the setting of bulky leaflet calcification that resulted in elevated valve gradients and were treated successfully using intraprocedural balloon dilation.