Predilatation in Self-Expanding Valves

TAVI has become the treatment of choice in specific scenarios. However, predilatation (PRD) remains a matter of debate, both in balloon-expandable and self-expanding valves.

Currently, there are analyses in which PRD was performed or even considered mandatory, and others where it was not carried out, yielding controversial results regarding this strategy.

An analysis of the BAVSE-TAVI Registry (Balloon Aortic Valvuloplasty before Self-Expanding TAVI) was conducted, including 315 consecutive patients with symptomatic severe aortic stenosis treated with TAVI, of whom 158 underwent PRD.

The valves used were Evolut PRO, PRO+, and FX (Medtronic, Minneapolis, MN).

The Primary Endpoint (PE) was a composite of all-cause death, stroke, major vascular complications, major bleeding, significant paravalvular leak, or the need for a permanent pacemaker.

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Baseline characteristics were similar between groups: mean age of 81 years, EuroSCORE of 3.6%, renal dysfunction in 50%, atrial fibrillation in 23%, right bundle branch block in 6%, and left bundle branch block in 4%. Pacemaker implantation was more frequent in patients undergoing direct implantation (DI).

Patients who received PRD had higher peak velocity (4.5 vs. 4 m/s; p<0.001), smaller indexed aortic valve area (0.3 vs. 0.4; p<0.001), larger annulus area (446 vs. 408 mm²; p<0.001 and 76 vs. 73 mm²; p=0.012), and higher peak and mean gradients (84 vs. 69 mmHg; p<0.001 and 51 vs. 40 mmHg; p<0.001). They also presented with higher calcification scores and more bicuspid valves.

No differences were observed in valve diameters; however, post-dilatation was more frequent in patients who had undergone PRD.

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There were no significant differences in the PE, nor in death, stroke, vascular complications, paravalvular leak, or permanent pacemaker requirement. However, major bleeding was more frequent in the DI group (0.6% vs. 6.4%; p=0.005).

At two-year follow-up, no differences in mortality were observed (23.4% vs. 31.2%; p=0.131 for PRD and DI, respectively).

Conclusion

Both predilatation and direct implantation in TAVI can be safely performed in clinical practice. The choice of strategy should be based on patient characteristics assessed by echocardiography and computed tomography.

Original Title: Balloon Aortic Valvuloplasty Prior to Self‐Expanding TAVI: The BAVSE‐TAVI Registry. 

Reference: Abdalazeem Ibrahem, et a. Catheterization and Cardiovascular Interventions, 2025; 106:1674–1681.