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
Artigo
em Inglês
| Sec. Est. Saúde SP, CONASS, SESSP-IDPCPROD, Sec. Est. Saúde SP
| ID: biblio-1223467
Biblioteca responsável:
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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Coleções:
Bases de dados nacionais
/
Brasil
Base de dados:
CONASS
/
Sec. Est. Saúde SP
/
SESSP-IDPCPROD
Assunto principal:
Substituição da Valva Aórtica Transcateter
/
Hemodinâmica
Idioma:
Inglês
Revista:
Catheter. cardiovasc. interv
Ano de publicação:
2018
Tipo de documento:
Artigo
Instituição/País de afiliação:
Department of Cardiology, the Academic Medical Center/NL
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Department of Internal Medicine, Cardiology Division, University of Campinas (UNICAMP)/NL
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Division of Cardiology, Department of Clinical science and Medicine, Yamaguchi University, Graduate School of Medicine/JP
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Hospital Beneficência Portuguesa de São Paulo/BR
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Instituto Dante Pazzanese de Cardiologia, , Brazil/BR
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Fundação Universitária de Cardiologia and Universidade Federal de Ciencias da Saude de Porto Alegre+BR
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International Centre for Circulatory Health, NHLI, Imperial College London/GB
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The Heart Institute (InCor), University of São Paulo Medical School/BR
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Thoraxcenter, Erasmus Medical Center/NL