Determinants of success and hemodynamic impact of balloon postdilatation of self-expanding transcatheter aortic valves
Catheter. cardiovasc. interv
; 92(5): 945-953, Nov. 2018. tab, ilus
Article
in English
| Sec. Est. Saúde SP, CONASS, SESSP-IDPCPROD, Sec. Est. Saúde SP
| ID: biblio-1223467
Responsible library:
BR79.1
ABSTRACT
OBJECTIVES:
To explore the rate, the determinants of success, and the hemodynamic impact of balloon postdilatation (BPD) of self-expanding transcatheter heart valves (SE-THVs)Background:
BPD is commonly used to optimize valve expansion and reduce paravalvular leakage (PVL) after transcatheter aortic valve implantation (TAVI) without clearly knowing its hemodynamic benefits.METHODS:
Patients (n 5 307) who received a SE-THV were stratified according to whether a BPD was performed or not. Patients who received BPD were stratified according to the severity of PVL remaining after BPD into two groups Successful BPD ( mild PVL 1 BPD) and Failed BPD (moderate-severe PVL 1 BPD).RESULTS:
BPD was performed in 121 patients (39.4%) and was successful in 106 patients (87.6% of attempts). A ratio of the postdilatation balloon diameter to the annulus diameter 0.95 was an independent predictor of BPD failure (OR 10.72 [2.02-56.76], P 5 .005). Peak transvalvular pressure gradient (PG) was lower in the Successful BPD group (14[12-22] mm Hg) than in the Failed BPD group (18[16-23] mm Hg, P 5 .029), and did not rise in either group during follow-up (median [IQR], 364[161-739] days).CONCLUSION:
BPD was performed in 39% of patients who received a SE-THV, and was successful in the majority of attempts. BPD failure was more likely in patients with a small postdilatation balloon-to-annulus diameter ratio. Effective BPD improved THV hemodynamic performance, and this was maintained in the intermediate-term post-TAVI.
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Collection:
National databases
/
Brazil
Database:
CONASS
/
Sec. Est. Saúde SP
/
SESSP-IDPCPROD
Main subject:
Transcatheter Aortic Valve Replacement
/
Hemodynamics
Language:
English
Journal:
Catheter. cardiovasc. interv
Year:
2018
Document type:
Article
Institution/Affiliation country:
Department of Cardiology, the Academic Medical Center/NL
/
Department of Internal Medicine, Cardiology Division, University of Campinas (UNICAMP)/NL
/
Division of Cardiology, Department of Clinical science and Medicine, Yamaguchi University, Graduate School of Medicine/JP
/
Hospital Beneficência Portuguesa de São Paulo/BR
/
Instituto Dante Pazzanese de Cardiologia, , Brazil/BR
/
Fundação Universitária de Cardiologia and Universidade Federal de Ciencias da Saude de Porto Alegre+BR
/
International Centre for Circulatory Health, NHLI, Imperial College London/GB
/
The Heart Institute (InCor), University of São Paulo Medical School/BR
/
Thoraxcenter, Erasmus Medical Center/NL