Abstract 17182: Leveraging Preparatory Balloon Aortic Valvuloplasty During TAVI for Improved Valve Sizing - A Simple Way to Reduce Paravalvular Aortic Regurgitation ?!
Background: Currently, valve-size selection for TAVI is based on annular measurements by echocardiography or CT. Still, relevant paravalvular regurgitation (PAR) with negative impact on survival is found in up to 20% of cases. We sought to evaluate whether supraaortic angiography during balloon aortic valvuloplasty (BAV) may provide improved annular-sizing with PAR reduction, especially in cases with annuli of borderline size (figure).
Methods: Data of 167 consecutive patients (pts) with conventional sizing by echocardiography and CT (group 1) were compared to 103 successive pts, in which BAV was, additionally leveraged for size-selection (group 2). PAR was graded angiographically (Sellers criteria) and quantitatively using the pressure difference between diastolic aortic pressure and LVEDP ([[Unable to Display Character: ▵]]P DAP[[Unable to Display Character: –]]LVEDP) and the myocardial supply-demand ratio (DPTI:SPTI), a [[Unable to Display Character: ▵]]p DAP[[Unable to Display Character: –]]LVEDP ≤ 18 mmHg and a DPTI:SPTI of ≤ 0.7 having previously been proposed as cut-off values associated with increased cardiovascular mortality.
Results: TAVI was technically successful in all pts (ES: 166, MCV: 104). PAR was observed in 113 pts of group 1 and 41 pts of group 2 (67% vs 40%, p<0.05 ). Moderate or moderate-to-severe PAR by angiography, a [[Unable to Display Character: ▵]]p DAP[[Unable to Display Character: –]]LVEDP ≤ 18 mmHg and a DPTI:SPTI ≤ 0.7 were observed more frequently in group 1 compared to group 2: 14.4 vs. 7.8 %, 26.3 vs. 14.5 % and 11.9 vs. 6.7 % (all p-values <0.05).According to preinterventional imaging, 40 (39%) pts had a borderline annulus size, raising uncertainty regarding valve-size selection. Balloon-sizing (BS) resulted in selection of the “bigger” prosthesis in 21 pts; only 2 pts had relevant PAR in these 40 cases. Cardiovascular mortality at 30 days and 1-year was significantly decreased in group 2 compared to group 1 (5,8 vs. 9 % and 10.6 vs. 20%, p<0.05). No complications were associated with BS.
Conclusion: Preparatory BAV during TAVI can be leveraged to improve valve-size selection and reduce associated PAR, especially in borderline cases.
- © 2012 by American Heart Association, Inc.