11. Transcathether implantation without preballoon dilation – How can echocardiography help

Abstract

Abstract Type Clinical Research. Presentation Type Oral Presentation. Introduction Transcatheter aortic valve implantation (TAVI) is performed usually with preballoon dilation (PBD) which has its pros and cons. The aim of this study was to show the role of transesophageal echocardiographic (TEE) in selection of patients for TAVI without PBD and compare the results with those underwent PBD. Methodology 62 consecutive patients with severe symptomatic aortic stenosis underwent TEE evaluation before TAVI. 2D and 3D TEE imaging was used to assess aortic valve for suitability for direct valve implantation without PBD. Using echocardiographic criteria including sinotubular junction diameter, intersinus diameter, valve area, calcification, and degree of AR, echocardiographer agreed with the interventionist to consider patients either for TAVI with PBD or without PBD. We have 2 groups, group A underwent TAVI without PBD (n = 23) and group B underwent TAVI with PBD (n = 39). Results 62 patients (median age, 80.2 ± 11.7 years) with severe AS were evaluated. The mean aortic valve area was 0.74 ± 0.17 cm2. In group A, Edward valves were implanted in 21.7% (n = 5) and Core valves in 78.3% (n = 18). In group B, Edward valves were implanted in 46.2% (n = 18) and Core valves in 53.8% (n = 21). Post implantation balloon dilation to decrease or eliminate paravalvular leak was done in 21.7% (n = 5) in group A, vs 20.5% (n = 8) in group B, P = 0.9. In group A, residual paravalvular leak was seen in 13% vs 28.2% in group B, P = 0.2. Procedure-related mortality was not signii¬_cantly differ in both groups 4.3% (n = 1) vs 5.1% (n = 2), P = 0.89 and also longterm mortality at 29 ± 5 months, 17.4% (n = 4) vs 23.1% (n = 9) P = 0.59. Conclusion Pre TAVI TEE assessment of aortic valve can give a great help in selection of patients for TAVI without BPD which is feasible and safe. In our patients there was no difference in paravalvular leak or mortality in both groups.