Is post dilatation useful after implantation of the Edwards valve?

Abstract

Background: Little data is available about post-dilatation (PD) for the treatment of significant paravalvular aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) of the Edwards valve. Methods and results: A total of 470 patients, aged 83.4±6.4years, logistic Euroscore 21.9±12.3, undergoing TAVI with the Edwards valve were evaluated. PD was performed using the balloon delivery system when significant paravalvular AR was identified. The diameter of the valve was measured from cine acquisition at 3 different levels. PD was performed in 49 patients (10.4%) with grade 2, 3 or 4 AR in 42.1%, 55.3%, and 2.6%, respectively. After PD, a reduction of at least 1 degree of AR was achieved in 81.5% of cases (residual AR grade 2, 3 and 4 in 36.8%, 10.5%, and 0%, respectively). A significant increase in the prosthesis diameter was observed at the 3 valve levels (AbsoluteΔ3.5%-5.4%, p<0.01). For the 23mm valve, mid level of valve increased from 23.0±0.4 to 24.1±0.5mm (p<0.01) and for the 26mm, from 25.2±0.9 to 26.6±0.9mm (p<0.01). Occurrence of annulus rupture (4.2 vs 1.7%, p=0.24), cerebrovascular accidents (2.6 vs 2.4%, p=0.63), need for new pacemaker (8.3 vs 4.3%, p=0.31) and 30-day composite endpoint (25.5 vs 21.3%, p=0.50) were similar between PD and non PD group. Conclusions: PD for the treatment of significant paravalvular leak after Edwards valve implantation is associated with a significant increase in valve diameter and decrease by at least one AR grade in 81.5% of cases. This promising approach may improve long-term outcome and warrants further investigation.