Balloon-expandable transaortic transcatheter aortic valve implantation with or without predilation

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Bonaros , N , Kofler , M , Frank , D , Cocchieri , R , Jagielak , D , Aiello , M , Lapeze , J , Laine , M , Chocron , S , Muir , D , Eichinger , W , Thielmann , M , Labrousse , L , Bapat , V , Rein , K A , Verhoye , J-P , Gerosa , G , Baumbach , H , Deutsch , C , Bramlage , P , Thoenes , M & Romano , M 2018 , ' Balloon-expandable transaortic transcatheter aortic valve implantation with or without predilation ' , Journal of Thoracic and Cardiovascular Surgery , vol. 155 , no. 3 , pp. 915-923 . https://doi.org/10.1016/j.jtcvs.2017.10.071

Title: Balloon-expandable transaortic transcatheter aortic valve implantation with or without predilation
Author: Bonaros, Nikolaos; Kofler, Markus; Frank, Derk; Cocchieri, Riccardo; Jagielak, Dariusz; Aiello, Marco; Lapeze, Joel; Laine, Mika; Chocron, Sidney; Muir, Douglas; Eichinger, Walter; Thielmann, Matthias; Labrousse, Louis; Bapat, Vinayak; Rein, Kjell Arne; Verhoye, Jean-Philippe; Gerosa, Gino; Baumbach, Hardy; Deutsch, Cornelia; Bramlage, Peter; Thoenes, Martin; Romano, Mauro
Contributor: University of Helsinki, Kardiologian yksikkö
Date: 2018-03
Language: eng
Number of pages: 9
Belongs to series: Journal of Thoracic and Cardiovascular Surgery
ISSN: 0022-5223
URI: http://hdl.handle.net/10138/300990
Abstract: Objective: It has been reported that balloon aortic valvuloplasty immediately before transfemoral or transapical transcatheter aortic valve implantation has mostly little to no clinical value. We aimed to provide data on the need for balloon aortic valvuloplasty in patients undergoing transaortic transcatheter aortic valve implantation. Methods: Patients undergoing transaortic transcatheter aortic valve implantation with the Edwards SAPIEN XT (Nyon, Switzerland) or 3 transcatheter heart valve were prospectively included at 18 sites across Europe. In the present analysis, we compare the periprocedural and 30-day outcomes of patients undergoing conventional (thorn balloon aortic valvuloplasty) versus direct (-balloon aortic valvuloplasty) transaortic transcatheter aortic valve implantation. Results: Of the 300 patients enrolled, 222 underwent conventional and 78 underwent direct transaortic transcatheter aortic valve implantation. Peak and mean transvalvular gradients were improved in both groups with no significant difference between groups. Procedural duration, contrast agent volume, and requirement for postdilation were also comparable. A trend toward fewer periprocedural complications was evident in the direct group (3.9% vs 11.3%; P = .053), with significantly lower rates of permanent pacemaker implantation (0% vs 5.0%; P = .034). Balloon aortic valvuloplasty omission had no significant effect on any of the 30-day safety and efficacy outcomes, including Valve Academic Research Consortium-2 composite end points (early safety events: 22.7% vs 17.4%, odds ratio, 1.17, 95% confidence interval, 0.53-2.62; clinical efficacy events: 20.5% vs 18.7%, odds ratio, 1.14, 95% confidence interval, 0.51-2.55). Conclusions: For many patients, balloon aortic valvuloplasty predilation seems to have little clinical value in transaortic transcatheter aortic valve implantation using a balloon expandable transcatheter valve and may result in a higher rate of periprocedural complications, particularly in terms of permanent pacemaker implantation.
Subject: aortic stenosis
balloon aortic valvuloplasty
predilation
transaortic
transcatheter aortic valve
implantation
CASE-MATCHED ANALYSIS
EDWARDS SAPIEN XT
VALVULOPLASTY
REPLACEMENT
FEASIBILITY
SAFETY
ACCESS
3121 General medicine, internal medicine and other clinical medicine
3126 Surgery, anesthesiology, intensive care, radiology
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