OBJECTIVES: This study sought to evaluate whether supra-aortic angiography during preparatory balloon aortic valvuloplasty (BAV) improves valve sizing. BACKGROUND: Current recommendations for valve size selection are based on annular measurements by transesophageal echocardiography and computed tomography, but paravalvular aortic regurgitation (PAR) is a frequent problem. METHODS: Data of 270 consecutive patients with either conventional sizing (group 1, n = 167) or balloon aortic valvuloplasty-based sizing (group 2, n = 103) were compared. PAR was graded angiographically and quantitatively using several hemodynamic indices. RESULTS: PAR was observed in 113 patients of group 1 and 41 patients of group 2 (67.7% vs. 39.8%, p < 0.001). More than mild PAR was found in 24 (14.4%) patients of group 1 and 8 (7.8%) patients of group 2. According to pre-interventional imaging, 40 (39%) patients had a borderline annulus size, raising uncertainty regarding valve size selection. Balloon sizing resulted in selection of the bigger prosthesis in 30 (29%) and the smaller prosthesis in the remaining patients, and only 1 of these 40 patients had more than mild PAR. As predicted by the hemodynamic indices of PAR, mortality at 30 days and 1 year was less in group 2 than in group 1 (5.8% vs. 9%, p = 0.2 and 10.6% vs. 20%, p = 0.01). CONCLUSIONS: Preparatory balloon aortic valvuloplasty during transcatheter aortic valve implantation improves valve size selection, reduces the associated PAR, and increases survival in borderline cases.
OBJECTIVES: This study sought to evaluate whether supra-aortic angiography during preparatory balloon aortic valvuloplasty (BAV) improves valve sizing. BACKGROUND: Current recommendations for valve size selection are based on annular measurements by transesophageal echocardiography and computed tomography, but paravalvular aortic regurgitation (PAR) is a frequent problem. METHODS: Data of 270 consecutive patients with either conventional sizing (group 1, n = 167) or balloon aortic valvuloplasty-based sizing (group 2, n = 103) were compared. PAR was graded angiographically and quantitatively using several hemodynamic indices. RESULTS: PAR was observed in 113 patients of group 1 and 41 patients of group 2 (67.7% vs. 39.8%, p < 0.001). More than mild PAR was found in 24 (14.4%) patients of group 1 and 8 (7.8%) patients of group 2. According to pre-interventional imaging, 40 (39%) patients had a borderline annulus size, raising uncertainty regarding valve size selection. Balloon sizing resulted in selection of the bigger prosthesis in 30 (29%) and the smaller prosthesis in the remaining patients, and only 1 of these 40 patients had more than mild PAR. As predicted by the hemodynamic indices of PAR, mortality at 30 days and 1 year was less in group 2 than in group 1 (5.8% vs. 9%, p = 0.2 and 10.6% vs. 20%, p = 0.01). CONCLUSIONS: Preparatory balloon aortic valvuloplasty during transcatheter aortic valve implantation improves valve size selection, reduces the associated PAR, and increases survival in borderline cases.
Authors: Lenard Conradi; Andreas Schaefer; Moritz Seiffert; Johannes Schirmer; Ulrich Schaefer; Gerhard Schön; Stefan Blankenberg; Hermann Reichenspurner; Hendrik Treede; Patrick Diemert Journal: Clin Res Cardiol Date: 2015-03-01 Impact factor: 5.460
Authors: Robert J Lederman; Vasilis C Babaliaros; Toby Rogers; Jaffar M Khan; Norihiko Kamioka; Danny Dvir; Adam B Greenbaum Journal: JACC Cardiovasc Interv Date: 2019-07-08 Impact factor: 11.195
Authors: Rebecca T Hahn; Susheel Kodali; E Murat Tuzcu; Martin B Leon; Samir Kapadia; Deepika Gopal; Stamatios Lerakis; Brian R Lindman; Zuyue Wang; John Webb; Vinod H Thourani; Pamela S Douglas Journal: JACC Cardiovasc Imaging Date: 2015-03
Authors: Bo Fu; Qingliang Chen; Feng Zhao; Zhigang Guo; Nan Jiang; Xu Wang; Wei Wang; Jiange Han; Li Yang; Yanbo Zhu; Yanhe Ma Journal: Ann Transl Med Date: 2020-07