Usefulness of Predilation Before Transcatheter Aortic Valve Implantation

• Published in: The American journal of cardiology Vol. 118; no. 1; pp. 107 - 112
• Main Authors: Pagnesi, Matteo, MD, Jabbour, Richard J., MD, Latib, Azeem, MD, Kawamoto, Hiroyoshi, MD, Tanaka, Akihito, MD, Regazzoli, Damiano, MD, Mangieri, Antonio, MD, Montalto, Claudio, Ancona, Marco B., MD, Giannini, Francesco, MD, Chieffo, Alaide, MD, Montorfano, Matteo, MD, Monaco, Fabrizio, MD, Castiglioni, Alessandro, MD, Alfieri, Ottavio, MD, Colombo, Antonio, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2016; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Aortic Valve Stenosis - complications; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - surgery; Balloon Valvuloplasty; Calcification; Cardiology; Cardiovascular; Cardiovascular disease; Chronic obstructive pulmonary disease; Confidence intervals; Coronary vessels; Disease-Free Survival; Female; Heart attacks; Humans; Logistics; Male; Mortality; Multivariate analysis; Propensity Score; Prostheses; Retrospective Studies; Stroke; Studies; Transcatheter Aortic Valve Replacement; Treatment Outcome; Variables
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2016.04.018

Balloon predilation is historically considered a requirement before performing transcatheter aortic valve implantation (TAVI). As the procedure has evolved, it has been questioned whether it is actually needed, but data are lacking on mid-term outcomes. The aim of this study was to evaluate the effect of balloon predilation before TAVI. A total of 517 patients who underwent transfemoral TAVI from November 2007 to October 2015 were analyzed. The devices implanted included the Medtronic CoreValve (n = 216), Medtronic Evolut R (n = 30), Edwards SAPIEN XT (n = 210), and Edwards SAPIEN 3 (n = 61). Patients were divided into 2 groups depending on whether pre-implantation balloon aortic valvuloplasty (pre-BAV) was performed (n = 326) or not (n = 191). Major adverse cardiac and cerebrovascular events (MACCE) were primarily evaluated. Propensity score matching was used to adjust for differences in baseline characteristics and potential confounders (n = 113 pairs). In the overall cohort, patients without pre-BAV had a significantly higher MACCE rate at 30 days, driven by a higher incidence of stroke (0.3% pre-BAV vs 3.7% no-pre-BAV, p <0.01). MACCE and mortality at 1 year were, however, similar in both groups. Independent predictors of MACCE at 1 year included serum creatinine, NYHA class 3 to 4, logistic European System for Cardiac Operative Risk Evaluation, and postdilation. Of note, the postdilation rate was higher in the no-pre-BAV group (21.5% pre-BAV vs 35.6% no-pre-BAV, p <0.001). After propensity score matching, there were no differences in MACCE between the 2 groups. In conclusion, this study showed that, in selected patients and with specific transcatheter valves, TAVI without pre-BAV appears to be associated with similar mid-term outcomes compared with TAVI with pre-BAV, but it may increase the need for postdilation.