BACKGROUND: Balloon pre-dilatation before transcatheter aortic valve replacement (TAVR) is performed at the discretion of the treating physician. Clinical data assessing the implications of this step on procedural outcomes are limited. METHODS: We conducted a retrospective analysis of 1164 consecutive TAVR patients in the Israeli multicenter TAVR registry (Sheba, Rabin, and Tel Aviv Medical Centers) between the years 2008 and 2014. Patients were divided to those who underwent balloon pre-dilation (n=1026) versus those who did not (n=138). RESULTS: Rates of balloon pre-dilation decreased from 95% in 2008-2011 to 59% in 2014 (p for trend=0.002). Baseline characteristics between groups were similar except for more smoking (22% vs. 8%, p=0.008), less past CABG (18% vs. 26%, p=0.016), less diabetes mellitus (35% vs. 45%, p=0.01), and lower STS mortality scores (5.2±3.7 vs. 6.1±3.5, p=0.006) in the pre-dilatation group. The pre-dilation group included less patients with moderate to severely depressed LVEF (7% vs. 16%, p<0.001) and higher aortic peak gradients (76.9±22.7mmHg vs. 71.4±24.3mmHg, p=0.01). Stroke rates were comparable in both groups (2.5% vs. 3%, p=0.8), but pre-dilation was associated with lower rates of balloon post-dilatation (9% vs. 26%, p<0.001). On multivariate analysis, balloon pre-dilatation was not a predictor of device success or any post-procedural complications (p=0.07). CONCLUSIONS: Balloon pre-dilatation was not associated with procedural adverse events and may decrease the need for balloon post-dilatation. The results of the present study support the current practice to perform liberally balloon pre-dilatation prior to valve implantation.
BACKGROUND: Balloon pre-dilatation before transcatheter aortic valve replacement (TAVR) is performed at the discretion of the treating physician. Clinical data assessing the implications of this step on procedural outcomes are limited. METHODS: We conducted a retrospective analysis of 1164 consecutive TAVR patients in the Israeli multicenter TAVR registry (Sheba, Rabin, and Tel Aviv Medical Centers) between the years 2008 and 2014. Patients were divided to those who underwent balloon pre-dilation (n=1026) versus those who did not (n=138). RESULTS: Rates of balloon pre-dilation decreased from 95% in 2008-2011 to 59% in 2014 (p for trend=0.002). Baseline characteristics between groups were similar except for more smoking (22% vs. 8%, p=0.008), less past CABG (18% vs. 26%, p=0.016), less diabetes mellitus (35% vs. 45%, p=0.01), and lower STS mortality scores (5.2±3.7 vs. 6.1±3.5, p=0.006) in the pre-dilatation group. The pre-dilation group included less patients with moderate to severely depressed LVEF (7% vs. 16%, p<0.001) and higher aortic peak gradients (76.9±22.7mmHg vs. 71.4±24.3mmHg, p=0.01). Stroke rates were comparable in both groups (2.5% vs. 3%, p=0.8), but pre-dilation was associated with lower rates of balloon post-dilatation (9% vs. 26%, p<0.001). On multivariate analysis, balloon pre-dilatation was not a predictor of device success or any post-procedural complications (p=0.07). CONCLUSIONS: Balloon pre-dilatation was not associated with procedural adverse events and may decrease the need for balloon post-dilatation. The results of the present study support the current practice to perform liberally balloon pre-dilatation prior to valve implantation.
Authors: Jannik Ole Ashauer; Nikolaos Bonaros; Markus Kofler; Gerhard Schymik; Christian Butter; Mauro Romano; Vinayak Bapat; Justus Strauch; Holger Schröfel; Andreas Busjahn; Cornelia Deutsch; Peter Bramlage; Jana Kurucova; Martin Thoenes; Stephan Baldus; Tanja K Rudolph Journal: BMC Cardiovasc Disord Date: 2019-07-19 Impact factor: 2.298
Authors: Anat Berkovitch; Amit Segev; Elad Maor; Alexander Sedaghat; Ariel Finkelstein; Matteo Saccocci; Ran Kornowski; Azeem Latib; Jose M De La Torre Hernandez; Lars Søndergaard; Darren Mylotte; Niels Van Royen; Azfar G Zaman; Pierre Robert; Jan-Malte Sinning; Arie Steinvil; Francesco Maisano; Katia Orvin; Gianmarco Iannopollo; Dae-Hyun Lee; Ole De Backer; Federico Mercanti; Kees van der Wulp; Joy Shome; Didier Tchétché; Israel M Barbash Journal: J Pers Med Date: 2022-06-28
Authors: Tobias Tichelbäcker; Leonard Bergau; Miriam Puls; Tim Friede; Tobias Mütze; Lars Siegfried Maier; Norbert Frey; Gerd Hasenfuß; Markus Zabel; Claudius Jacobshagen; Samuel Sossalla Journal: PLoS One Date: 2018-10-17 Impact factor: 3.240