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Balloon-expandable transcatheter heart valves for treatment of aortic valve stenosis in patients with large aortic annuli: Evaluation of deployment balloon overfilling strategies.

Authors :
Schneeberger Y
Sarwari H
Köll B
Demal TJ
Bhadra OD
von der Heide I
Hannen L
Grundmann D
Voigtländer L
Waldschmidt L
Schirmer J
Pecha S
Schofer N
Sörensen N
Blankenberg S
Reichenspurner H
Conradi L
Seiffert M
Schaefer A
Source :
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions [Catheter Cardiovasc Interv] 2024 Jan; Vol. 103 (1), pp. 194-201. Date of Electronic Publication: 2023 Nov 30.
Publication Year :
2024

Abstract

Objectives: Transcatheter aortic valve implantation (TAVI) using balloon-expandable (BE) transcatheter heart valves (THV) in aortic annuli above 29 mm includes particular procedural steps, mainly involving overfilling of the deployment balloon. Data on overfilling strategies in clinical daily practice is scarce. We herein aimed for a retrospective description of utilized overfilling strategies in those patients.<br />Methods: Between January 2016 and December 2022, 45 patients (100% male, 76.9 ± 6.1 years) received TAVI in aortic annuli above 29 mm using a BE THV. Overfilling volumina of the deployment balloon were left to operators' discretion. Clinical and multislice computed tomography data were retrospectively collected. Clinical endpoints were adjudicated in accordance with the updated standardized VARC-3 definitions.<br />Results: Profound overfilling (+4/5 mL) was used in patients with a mild calcium burden (˂750 mm³) even in aortic annuli of 29.0-30.0 mm. Nominal/slight overfilling (+1 mL) was used in aortic annuli up to 32.5 mm but an intermediate to severe calcific burden (>750-3200 mm³). Accordingly, a low calcification group (˂750 mm³, n = 17) compared to a significant calcification group (≥750 mm³, n = 28), presented with higher overfilling volumina (2.1 ± 1.4 vs. 0.8 ± 1.0; p ˂ 0.001), although aortic annulus diameter was not different (29.8 ± 0.8 vs. 29.9 ± 0.9 mm; p = 0.7). All-cause 30-day mortality was 0%. Device success was 97.8%. Transvalvular mean pressure gradient at discharge was 9.5 ± 3.6 mmHg. No case of PVL >mild was documented.<br />Conclusion: Extent of overfilling of the deployment balloon largely depends on calcification burden in addition to aortic annulus diameter with significant and profound overfilling particularly in patients with a calcification burden of the aortic valve complex ˂750 mm³.<br /> (© 2023 Wiley Periodicals LLC.)

Details

Language :
English
ISSN :
1522-726X
Volume :
103
Issue :
1
Database :
MEDLINE
Journal :
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
Publication Type :
Academic Journal
Accession number :
38037296
Full Text :
https://doi.org/10.1002/ccd.30922