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Underexpansion and ad hoc post-dilation in selected patients undergoing balloon-expandable transcatheter aortic valve replacement.
- Source :
-
Journal of the American College of Cardiology [J Am Coll Cardiol] 2014 Mar 18; Vol. 63 (10), pp. 976-81. Date of Electronic Publication: 2013 Nov 06. - Publication Year :
- 2014
-
Abstract
- Objectives: This study sought to assess the clinical outcomes and hemodynamic performance associated with a strategy of underexpanding balloon-expandable transcatheter heart valves (THV) when excessive oversizing is a concern.<br />Background: Transcatheter aortic valve replacement depends on the selection of an optimally sized THV. An undersized THV may lead to paravalvular regurgitation, whereas excessive oversizing may lead to annular injury.<br />Methods: Patients (n = 47) who underwent transcatheter aortic valve replacement with an intentionally underexpanded THV (balloon-filling volume reduced ~10%) were compared with consecutive control patients who had nominal THV balloon deployment (n = 87). Pre- and post-procedural computed tomography imaging and echocardiography were performed to assess THV stent expansion and hemodynamics.<br />Results: Underfilling resulted in THV underexpansion that was maximal at the THV inflow (85.0 ± 7.4% vs. 102.5 ± 6.2%, p < 0.001), in study versus control groups, respectively. The study group received larger THV, although annular injury was not observed. Post-dilation was required in 10.6% and 4.6% of patients of the study and control groups, respectively (p = 0.165). Echocardiographic THV area, gradient, paravalvular regurgitation, and in-hospital outcomes were similar.<br />Conclusions: Intentionally underexpanding balloon-expandable THV by underfilling the deployment balloon did not adversely affect procedural clinical outcomes, THV gradients, or THV areas. A strategy of underexpansion, with post-dilation as necessary, might play in role in reducing the risk of annular injury and paravalvular regurgitation in selected patients.<br /> (Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged, 80 and over
Aortic Valve Stenosis diagnosis
Echocardiography, Transesophageal
Female
Follow-Up Studies
Humans
Male
Multidetector Computed Tomography
Prosthesis Design
Tomography, X-Ray Computed
Treatment Outcome
Aortic Valve Stenosis surgery
Cardiac Catheterization methods
Heart Valve Prosthesis Implantation methods
Patient Selection
Subjects
Details
- Language :
- English
- ISSN :
- 1558-3597
- Volume :
- 63
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Journal of the American College of Cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 24211502
- Full Text :
- https://doi.org/10.1016/j.jacc.2013.10.014