Bespoke valve sizing avoids annular rupture in patients treated with a balloon‐expandable transcatheter heart valve Journal Articles uri icon

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abstract

  • AbstractBackgroundAnnular and left ventricular outflow tract (LVOT) calcification increase the risk of annular rupture following transcatheter aortic valve replacement (TAVR). The outcomes of a strategy of routine use of a balloon‐expandable valve (BEV) for all patients irrespective of annular or LVOT calcium is unknown.ObjectivesWe evaluated the impact of bespoke sizing on annular rupture in patients treated with a BEV.MethodsAll consecutive patients undergoing TAVR at a single centre (February 2020–February 2022) were treated only with a BEV. No other valve design was used. Annular/LVOT calcification was assessed using a standardized grading system. For each annular area, we determined the percentage valve oversizing with nominal deployment. The balloon deployment volume was then adjusted when required (over‐/underfilled) to achieve over‐sizing of approximately 5% in the presence of annular/LVOT calcium and 5%–10% in the absence of annular/LVOT calcium. Adjusted valve areas were assumed to change proportionately to the change in balloon deployment volume.ResultsAmong 533 TAVR treated patients, annular/LVOT calcification was present in 166 (31.1%) and moderate or severe in 90 (16.9%). In patients with annular/LVOT calcification, the adjusted oversizing was 3.5 ± 3.6% and in patients without annular/LVOT calcification, the adjusted oversizing was 6.8 ± 4.7% (p < 0.001). There were no cases of annular rupture and no cases with more than mild paravalvular leak (PVL). Mild PVL was more frequent in patients with annular/LVOT calcium (10.8% vs 4.6%, p = 0.01).ConclusionBespoke BEV sizing by adjustment of balloon deployment volume avoided annular rupture in patients undergoing TAVR.

publication date

  • November 2022