Key result
Routine pre-implantation BAV offers no clear benefit for TAVI, supporting a selective-use strategy.
Why the study?
The need for routine pre-implantation balloon aortic valvuloplasty before transcatheter aortic valve implantation is debated due to advances in device design and operator experience.
Answers are grounded in this paper and cite their sources.
Balloon aortic valvuloplasty (BAV) has historically been recommended prior to transcatheter aortic valve implantation (TAVI). Pre-implantation BAV (pBAV) creates fractures at the level of calcified leaflets, thereby facilitating delivery of the transcatheter valve system across the diseased aortic valve and, enhances prosthesis implantation and expansion within the calcified aortic valve annulus. New device designs, lower profile delivery systems and increasing operator experience have enabled direct-TAVI (without pBAV), and its appeal amongst TAVI operators enhanced the dissemination of a direct TAVI approach across many centres. In this review, we discuss contemporary evidence that inform the debate on the need for routine pBAV for TAVI candidates and present a framework that may assist operators in selecting patients for pBAV.
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Kotronias et al. (2018) conducted a review in Transcatheter aortic valve implantation (TAVI) candidates. Pre-implantation balloon aortic valvuloplasty (pBAV) vs. Direct TAVI (without pBAV) was evaluated. This review summarizes contemporary evidence regarding the need for routine pre-implantation balloon aortic valvuloplasty for TAVI and presents a framework for patient selection.
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