High-pressure post-dilation following transcatheter valve-in-valve implantation in small surgical valves

Tarun Chakravarty, Justin Cox, Yigal Abramowitz, Sharjeel Israr, Abhimanyu Uberoi, Sunghan Yoon, Damini Dey, Paya Zadeh, Wen Cheng, Raj R. Makkar

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Aims: Residual gradients <20 mmHg after transcatheter valve-in-valve (ViV) implantation are associated with worse survival. This study aimed to evaluate the feasibility of high-pressure post-dilation with a non-compliant balloon after transcatheter ViV implantation in small surgical valves to optimise haemodynamics. Methods and results: Thirty patients underwent ViV implantation in surgical valves with internal dimension ≤19 mm. High-pressure post-dilation to 16-20 atmospheres with a non-compliant balloon was performed in 12 patients and 18 patients underwent ViV without post-dilation. SAPIEN 3 and Evolut valves were used in 10 and two patients, respectively. The mean aortic valve (AV) gradient decreased by 11.3 mmHg following high-pressure post-dilation (18.7±7.9 mmHg immediately post ViV to 7.5±2.6 mmHg following high-pressure post-dilation, p<0.01). There were no cases of aortic root rupture. High-pressure post-dilation, compared to no post-dilation, was associated with lower invasive AV mean gradients at the end of the ViV procedure (8.2±3.5 mmHg vs. 17.3±7.9 mmHg, p=0.001) as well as lower day 1 (18.0±4.5 mmHg vs. 25.0±8.1 mmHg, p=0.016) and 30-day gradients (19.8±2.5 vs. 26.5±11.0, p=0.038) on transthoracic echocardiography. Conclusions: High-pressure post-dilation of small surgical valves following transcatheter ViV implantation results in a significant improvement in post-procedure haemodynamics.

Original languageEnglish
Pages (from-to)158-165
Number of pages8
JournalEuroIntervention
Volume14
Issue number2
DOIs
StatePublished - 1 Jun 2018
Externally publishedYes

Keywords

  • Degenerative valve
  • TAVI
  • Valve-in-valve

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