Post-Dilation of Self-Expanding Valves: Frequency, Usefulness, and Risks

This study explores the impact of balloon post-dilation on studies conducted in the United States assessing the CoreValve self-expandable valve.

Procedural details of 3532 patients were examined to determine whether post-dilation was performed after valve implantation. Best practice guidelines recommend post-dilation to improve suboptimal outcomes, being the most frequent alternative for treating moderate or severe paravalvular insufficiency.

Post-dilation was performed in 782 patients (22%); the most common (58.1%) indication was greater than or equal to moderate paravalvular insufficiency. 

Predictors for the need for post-dilation were the following:

• Baseline transvalvular gradients (p <0.001)
• Higher baseline aortic insufficiency (p <0.001)
• Larger annular diameter (p <0.001)
• Lower device (p <0.001)

Post-dilation was significantly less frequent with the 26-mm devices (17.9%) compared to the 31-mm devices (38.1%).

Post-dilation effectively reduced moderate or severe aortic insufficiency by around 75.6% (from 58.1% to 14.2%).

Clinical outcomes at 30 days and 1 year were similar in both groups, except for a higher rate of acute kidney insufficiency in patients who underwent post-dilation (p = 0.026), which could be explained by the additional aortography necessary for control.

The rate of major adverse cardiovascular and cerebrovascular events was 9.3% in the post-dilation group and 7.5% for other patients (p = ns). There was no increase in neurological events.

Conclusion

Post-dilation was performed in 22% of patients receiving a CoreValve valve, most frequently due to a need to reduce the degree of residual paravalvular aortic insufficiency. Post-dilation effectively and immediately improved outcomes and was not associated with an increase in neurological events.

Original title: Balloon Post-Dilation Following Implantation of a Self-Expanding Transcatheter Aortic Valve Bioprosthesis.

Reference: J. Kevin Harrison et al. J Am Coll Cardiol Intv 2017;10:168-75.

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