Key result
Pre-procedural planning and tailored post-dilatation mitigate risks of self-expanding TAVR underexpansion.
Why the study?
Underexpansion of self-expanding transcatheter aortic valves is a critical issue that can negatively impact long-term outcomes and remains a significant challenge despite advances in technique and prosthesis design.
This review outlines the mechanisms of self-expanding TAVI underexpansion and highlights essential pre-procedural and procedural strategies to mitigate complications.
Informs TAVI operators on underexpansion mechanisms; extends review literature but leaves open need for outcome trials.
Underexpansion of a self-expanding transcatheter aortic valve (TAVI) is a critical issue that can negatively impact long-term outcomes, including paravalvular leak, valve thrombosis, and increased mortality. This paper provides a comprehensive review of the pathophysiology and consequences of such complications, including three primary mechanisms: (1) infolding, (2) incorrect site of crossing and (3) true underexpansion. It also discusses strategies to address these challenges, including pre-procedural planning and procedural techniques to ensure proper valve deployment and expansion. Mitigating these issues is essential to improving both immediate and long-term outcomes in TAVI patients.
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D. et al. (2025) conducted a review in TAVI underexpansion. Management of TAVI underexpansion with self-expanding valves was evaluated. Underexpansion of self-expanding transcatheter aortic valves is a critical complication driven by infolding, incorrect site of crossing, and true underexpansion, requiring careful pre-procedural planning and tailored post-dilatation to mitigate risks.
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