Balloon-expandable transaortic transcatheter aortic valve implantation with or without predilation

The Journal of Thoracic and Cardiovascular Surgery

Sidney Chocron¹  Mika Laine²  Nikolaos Bonaros³  Jean-Philippe Verhoye⁴  Riccardo Cocchieri⁵  Dariusz Jagielak⁶  Douglas Muir⁷  Vinayak Bapat⁸  Matthias Thielmann⁹  Kjell Arne Rein^1,10  Marco Aiello^1,11  Gino Gerosa^1,12  Markus Kofler^1,13  Walter Eichinger^1,14  Joel Lapeze^1,15  Cornelia Deutsch^1,16  Derk Frank^1,17  Peter Bramlage^1,18  Hardy Baumbach^1,19  Louis Labrousse^2,20 

[1] Cardiothoracic Division, James Cook Hospital, Middlesbrough, United Kingdom;Cardiothoracic Surgery, Hospital Jean Minjoz, University Hospital of Besancon, Besancon, France;Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria;Department of Cardiac Surgery, University of Padova, Padova, Italy;Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdansk, Poland;Department of Cardiothoracic Surgery, Foundation IRCCS Policlinico S Matteo, Pavia University School of Medicine, Pavia, Italy;Department of Cardiothoracic Surgery, Klinikum Bogenhausen, Munich, Germany;Department of Cardiothoracic Surgery, Rikshospital Oslo, Oslo, Norway;Department of Cardiovascular Surgery, CHU Hospital of Bordeaux, Bordeaux, France;Department of Cardiovascular Surgery, CHU Rennes, Rennes, France;Department of Cardiovascular Surgery, Hospital Louis Pradel, Lyon, France;Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Germany;Department of Internal Medicine III (Cardiology and Angiology) UKSH, Campus Kiel, Kiel, Germany;Department of Thoracic and Cardiovascular Surgery, West-German Heart Centre, University Hospital Essen, Essen, Germany;Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland;Edwards Lifesciences, Medical Affairs/Professional Education, Nyon, Switzerland;Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands;Institut Hospitalier Jacques Cartier, Massy, France;Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany;St Thomas' Hospital, London, United Kingdom

关键词: aortic stenosis;    balloon aortic valvuloplasty;    predilation;    transaortic;    transcatheter aortic valve implantation;   

DOI  :  10.1016/j.jtcvs.2017.10.071

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectiveIt has been reported that balloon aortic valvuloplasty immediately before transfemoral or transapical transcatheter aortic valve implantation has mostly little to no clinical value. We aimed to provide data on the need for balloon aortic valvuloplasty in patients undergoing transaortic transcatheter aortic valve implantation.MethodsPatients undergoing transaortic transcatheter aortic valve implantation with the Edwards SAPIEN XT (Nyon, Switzerland) or 3 transcatheter heart valve were prospectively included at 18 sites across Europe. In the present analysis, we compare the periprocedural and 30-day outcomes of patients undergoing conventional (+ balloon aortic valvuloplasty) versus direct (− balloon aortic valvuloplasty) transaortic transcatheter aortic valve implantation.ResultsOf the 300 patients enrolled, 222 underwent conventional and 78 underwent direct transaortic transcatheter aortic valve implantation. Peak and mean transvalvular gradients were improved in both groups with no significant difference between groups. Procedural duration, contrast agent volume, and requirement for postdilation were also comparable. A trend toward fewer periprocedural complications was evident in the direct group (3.9% vs 11.3%; P = .053), with significantly lower rates of permanent pacemaker implantation (0% vs 5.0%; P = .034). Balloon aortic valvuloplasty omission had no significant effect on any of the 30-day safety and efficacy outcomes, including Valve Academic Research Consortium-2 composite end points (early safety events: 22.7% vs 17.4%, odds ratio, 1.17, 95% confidence interval, 0.53-2.62; clinical efficacy events: 20.5% vs 18.7%, odds ratio, 1.14, 95% confidence interval, 0.51-2.55).ConclusionsFor many patients, balloon aortic valvuloplasty predilation seems to have little clinical value in transaortic transcatheter aortic valve implantation using a balloon expandable transcatheter valve and may result in a higher rate of periprocedural complications, particularly in terms of permanent pacemaker implantation.

【 授权许可】

Unknown