Key result
High-pressure post-dilation in transcatheter ViV implantation is linked to a ~53% drop in mean gradients.
Why the study?
Residual gradients greater than 20 mmHg after transcatheter valve-in-valve implantation in small surgical valves are associated with worse survival, and the feasibility of high-pressure post-dilation to optimize haemodynamics was evaluated.
Does high-pressure post-dilation improve haemodynamics in patients undergoing transcatheter valve-in-valve implantation in small surgical valves?
Observational (n=30)
Does high-pressure post-dilation improve haemodynamics in patients undergoing transcatheter valve-in-valve implantation in small surgical valves?
Absolute Event Rate: 8.2% vs 17.3%
p-value: p=0.001
High-pressure post-dilation of small surgical valves following transcatheter ViV implantation significantly improves post-procedure haemodynamics without causing aortic root rupture.
May support high-pressure post-dilation in select ViV cases; hypothesis-generating and requires randomized confirmation before practice change.
AIMS: Residual gradients >20 mmHg after transcatheter valve-in-valve (ViV) implantation are associated with worse survival. This study aimed to evaluate the feasibility of high-pressure post-dilation with a non-compliant balloon after transcatheter ViV implantation in small surgical valves to optimise haemodynamics. METHODS AND RESULTS: Thirty patients underwent ViV implantation in surgical valves with internal dimension ≤19 mm. High-pressure post-dilation to 16-20 atmospheres with a non-compliant balloon was performed in 12 patients and 18 patients underwent ViV without post-dilation. SAPIEN 3 and Evolut valves were used in 10 and two patients, respectively. The mean aortic valve (AV) gradient decreased by 11.3 mmHg following high-pressure post-dilation (18.7±7.9 mmHg immediately post ViV to 7.5±2.6 mmHg following high-pressure post-dilation, p<0.01). There were no cases of aortic root rupture. High-pressure post-dilation, compared to no post-dilation, was associated with lower invasive AV mean gradients at the end of the ViV procedure (8.2±3.5 mmHg vs. 17.3±7.9 mmHg, p=0.001) as well as lower day 1 (18.0±4.5 mmHg vs. 25.0±8.1 mmHg, p=0.016) and 30-day gradients (19.8±2.5 vs. 26.5±11.0, p=0.038) on transthoracic echocardiography. CONCLUSIONS: High-pressure post-dilation of small surgical valves following transcatheter ViV implantation results in a significant improvement in post-procedure haemodynamics.
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Chakravarty et al. (2018) conducted an observational in Small surgical valves requiring transcatheter valve-in-valve implantation (n=30). High-pressure post-dilation with a non-compliant balloon vs. No post-dilation was evaluated on Invasive aortic valve mean gradients at the end of the procedure (p=0.001). High-pressure post-dilation after transcatheter valve-in-valve implantation significantly lowered invasive aortic valve mean gradients compared to no post-dilation (8.2 vs 17.3 mmHg; p=0.001).
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