Author + information
- Toby Rogers,
- Ron Waksman,
- J. Kevin Harrison,
- G. Michael Deeb,
- James Hermiller,
- Jeffrey Popma and
- Michael Reardon
Background: The Pivotal trials of transcatheter aortic valve replacement (TAVR) with the self-expanding CoreValve (CV) prosthesis mandated balloon pre-dilatation (BPD) for every patient. Since then, use of BPD has steadily fallen. However, the impact of BPD on prosthesis hemodynamics and clinical outcomes remains unclear.
Methods: We performed a retrospective analysis of 2,721 patients from the extreme- and high-risk cohorts of the CV Continued Access Study. Baseline characteristics, prosthesis hemodynamics and clinical outcomes were compared according to whether BPD was performed.
Results: Baseline characteristics were similar between the two groups with regard to age, STS score, frailty, left ventricular function, and cardiovascular risk factors. The Table summarizes key findings. A higher percentage of TAVR without BPD patients had history of prior aortic valvuloplasty (15.4 vs. 10.6%, p=0.001), but post-dilatation was more frequently required in patients without BPD. Patients who underwent BPD had larger aortic annuli, higher baseline gradients, and had a higher frequency of larger TAVR prostheses. There was no difference in the incidence of post-procedural aortic regurgitation or aortic gradient ≥20mmHg, or in stroke, TIA or all-cause mortality at 30 days and 1 year.
Conclusions: Balloon pre-dilatation can be performed safely with no increase in stroke, TIA or mortality at 30 days or 1 year. Pre-dilatation does not appear necessary to achieve satisfactory post-procedure hemodynamics.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Interventional Cardiology: TAVR 2
Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease
Presentation Number: 1195-196
- 2017 American College of Cardiology Foundation