Feasibility of Self-Expanding Transcatheter Aortic Valve Implantation without Balloon Aortic Valvuloplasty

Abstract

Objective: Balloon aortic valvuloplasty (BAV) is frequently performed during transcatheter aortic valve implantation (TAVI). However, there are currently limited data regarding the benefits and drawbacks of BAV with self-expanding valves. This study retrospectively compares valve function with and without BAV during TAVI using self-expanding valves.

Methods: From November 2015 to December 2023, our hospital conducted 363 consecutive TAVI procedures using self-expanding valves (CoreValve/Evolut series; Medtronic, Minneapolis, MN, USA). Excluding five perioperative deaths, we analyzed 358 cases: 147 without BAV and 211 with at least one BAV during the procedure. The cohort's mean age was 84.9 years, with 67% female patients. The criterion for performing BAV before TAVI (pre-BAV) was a preoperative mean pressure gradient of 60 mmHg or higher, and the criteria for performing BAV after TAVI (post-BAV) were: if moderate or severe paravalvular leakage was observed after valve deployment; if the post-TAVI mean pressure gradient was 15 mmHg or higher; and if frame underexpansion of the TAVI valve was noted. We assessed pre- and postoperative echocardiography, the incidence of symptomatic cerebral infarction within 30 days after TAVI, and 1-year mortality.

Results: Preoperative echocardiography revealed that the non-BAV group had a significantly larger valve area (0.71 ± 0.16 vs. 0.66 ± 0.19 cm², p < 0.01) and a lower mean pressure gradient (40.1 ± 9.3 vs. 58.2 ± 18.1 mmHg, p < 0.001). Postprocedural echocardiography demonstrated comparable valve areas in both groups (1.77 ± 0.39 vs. 1.78 ± 0.39 cm², p = 0.81) and single-digit mean pressure gradients (6.75 ± 2.9 mmHg vs. 7.66 ± 3.4 mmHg, p < 0.01). The incidence of symptomatic cerebral infarction within 30 days was lower in the non-BAV group (2.7% vs. 7.6%, p = 0.048), while the 1-year mortality rate was similar between groups (6.8% vs. 7.6%, p = 0.91, log-rank).

Conclusion: In selected cases of TAVI with a self-expanding bioprosthetic valve, the omission of BAV did not appear to adversely affect postoperative valve function. Moreover, avoiding BAV may help reduce the risk of potential adverse events, such as cerebral infarction.