Author + information
- Luis Nombela Franco1,
- Carlos Ferrera2,
- Eulogio Garcia3,
- Pilar Jimenez4,
- Corina Biagioni5,
- Nieves Gonzalo6,
- Ivan Nuñez-Gil7,
- Ana Viana8,
- Pablo Salinas9,
- Javier Escaned10,
- Antonio Fernandez-Ortiz11 and
- Carlos Macaya12
- 1Hospital Clínico San Carlos, Madrid, Spain
- 2Hospital Clínico San Carlos
- 3Hospital Clinico San Carlos, Madrid, Spain
- 4Hospital Clinico San Carlos, Madrid, Spain
- 5Hospital Clínico San Carlos
- 6Unknown, Madrid, Spain
- 7Hospital Clínico San Carlos
- 8Unknown, Madrid, Spain
- 9Hospital Clínico San Carlos, Madrid, Spain
- 10Hospital Clínico San Carlos, Madrid, Spain
- 11Hospital Clínico San Carlos
- 12Hospital Clinico de San Carlos, Madrid, Spain
Balloon aortic valvuloplasty (BAV) was considered a routine previous step in transcatheter aortic valve implantation (TAVI). Our aim was to evaluate the feasibility, safety and midterm hemodynamic results of direct TAVI without pre-implantation BAV.
A total of 339 consecutive patients who underwent transfemoral TAVR were prospectively selected. A 1:1 matching was conducted, pairing age, prosthesis type (self-expandable or balloon expandable) and size, and valve calcification grade (48% with moderate to severe valve calcification). Finally, 102 pairs (102 patients with previous BAV and 102 without BAV) were obtained.
Direct TAVR was feasible in all patients without any crossover to BAV group. Device success was achieved in 91.2% and 90.2% of cases in direct TAVR and pre-BAV groups (p=0.810), respectively, without any differences in balloon postdilation rate and residual aortic regurgitation. The amount of contrast agent, acute kidney injury and myocardial injury was significantly lower in the direct implantation group (p<0.05). No differences were found in 30-day and 1-year mortality between both groups (4.9% versus 9.8%, p=0.177 and 14.0% versus 23.8%, p=0.771, respectively). Hemodynamic parameters remained stable after 1-year follow-up in both groups.
Direct transfemoral TAVR without prior BAV was safe in patients with calcified severe aortic stenosis. Pre-implantation BAV could be omitted in patients undergoing TAVR, without influence in procedure success rate, and subsequent patients’ clinical course and valve hemodynamic performance.
STRUCTURAL: Valvular Disease: Aortic