Post-dilatation using the balloon-expandable valve delivery balloon with same volume (double-tap) to optimize transcatheter aortic valve expansion

Background Transcatheter heart valve (THV) underexpansion is associated with haemodynamic valve deterioration. Double inflation of balloon-expandable valves using the delivery balloon with unchanged volume (double-tap) may improve THV expansion, while minimizing the risk of complications. Aims To evaluate the efficacy of double-tap after transcatheter aortic valve implantation (TAVI) with SAPIEN-3 Ultra RESILIA (S3UR) valves. Methods This observational study included consecutive patients who underwent TAVI for severe native aortic stenosis and had same-volume double-tap, from November 2024 to September 2025. THV expansion and deformation were assessed fluoroscopically before and after double-tap after appropriate calibration. Thirty-day clinical outcomes were reported. Results Of 113 patients who underwent TAVI with same-volume double-tap (mean age: 79.3 ± 7.3 years, 26.5% female, 13.3% bicuspid anatomy), the median THV expansion before double-tap, at the inflow, mid-portion, and outflow was 88.6% (IQR: 86.4–90.4%), 80.1% (IQR: 77.3–82.3%), and 90.1% (IQR: 88.4–90.9%) respectively, and after double-tap increased to 96.4% (IQR: 94.6–98.4%), 90.8% (IQR: 88.6–92.9%), and 97.6% (IQR: 96.3–99.0%) (all P < .001). The largest increase in expansion following double-tap occurred in the THV mid-portion (median: 10.6% [IQR: 9.8–11.6%]). Multivariable predictors of the extent of minimum expansion improvement following double-tap were bicuspid anatomy (P = .005) and aortic valve calcium volume of >385 mm3 (median) (P = .046). The median THV deformation index decreased from 1.05 (IQR: 1.04–1.07) to 1.03 (IQR: 1.02–1.04) after double-tap (P < .001). Thirty-day mortality rate was 0.9%. Conclusion Routine double-tap post-dilatation of balloon-expandable valves improves THV expansion and frame deformation, without any clear safety signal. Bicuspid anatomy and aortic valve calcium burden predicted the extent of expansion improvement.