Predilation in TAVR: Definitive Data for Easier Decision-Making?

Direct implantation (without predilation) resulted non-inferior vs. the conventional strategy with prior balloon aortic valvuloplasty using the S3 prosthesis (even though this did not translate into a simplified procedure). In a few patients, the prosthesis was not able to cross the native valve, which resulted in device retrieval and subsequent valvuloplasty. According to these data, direct implantation is possible if patients are selected correctly and providing you did not expect any benefits out of it. 

Predilatación en TAVI ¿Datos definitivos para no complicarse tomando decisiones?

The DIRECTAVI (Direct Transcatheter Aortic Valve Implantation) was an open non-inferiority study which included patients with severe aortic stenosis receiving the Edwards SAPIEN 3 randomized to direct implantation vs. prior predilation with balloon aortic valvuloplasty. 

Procedural success rate with direct implantation was 80.2% and resulted non-inferior to the group with predilation (75.7%; p=0.02). There was no prosthetic mismatch or paravalvular aortic regurgitation in these groups. 

5.8% of patients randomized to direct implantation requiring predilation given the impossibility of crossing the native valve with the prosthesis. 

Complications were basically conduction problems requiring pacemaker implantation and resulted almost identical in both groups (20.9% vs 19%; p=0.7).


Read also: Virtual ACC 2020 | TICO: Ticagrelor Monotherapy in Acute Coronary Syndromes.


There were no differences between strategies in terms of procedural duration, contrast volume, radiation exposure and post dilation rate. 

Conclusion

TAVR with direct implantation was similar in terms of outcomes to TAVR with pre- dilation with no difference in procedural duration. It might be impossible to cross the stenotic valve with the prosthesis and therefore we must select patients accordingly. 

Original Title: Prior Balloon Valvuloplasty Versus Direct Transcatheter Aortic Valve Replacement Results From the DIRECTAVI Trial.

Reference: Florence Leclercq et al. J Am Coll Cardiol Intv 2020;13:594–602.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

TCT 2024 | TRISCEND II

This randomized study included 400 patients; 267 were treated with EVOQUE valve and 133 with optimal medical treatment (OMT). After one-year follow-up, there were no...

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...

TAVR in Young Low-Risk Patients

Transcatheter aortic valve replacement (TAVR) has established itself as an effective strategy for the treatment of severe aortic stenosis across different risk groups. While previous...

TAVR and Atrial Fibrillation: What Anticoagulants Should We Use?

The prevalence of atrial fibrillation (AF) in TAVR patients ranges from 15 to 30%, depending on series. This arrhythmia has been associated to higher...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 | TRISCEND II

This randomized study included 400 patients; 267 were treated with EVOQUE valve and 133 with optimal medical treatment (OMT). After one-year follow-up, there were no...

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...