Late Balloon Valvuloplasty for Transcatheter Heart Valve Dysfunction.

Details

Serval ID
serval:BIB_10925B43B4F5
Type
Article: article from journal or magazin.
Collection
Publications
Title
Late Balloon Valvuloplasty for Transcatheter Heart Valve Dysfunction.
Journal
Journal of the American College of Cardiology
Author(s)
Akodad M., Blanke P., Chuang M.A., Duchscherer J., Sellers S.L., Chatfield A.G., Gulsin G.G., Lauck S., Leipsic J.A., Meier D., Moss R.R., Cheung A., Sathananthan J., Wood D.A., Ye J., Webb J.G.
ISSN
1558-3597 (Electronic)
ISSN-L
0735-1097
Publication state
Published
Issued date
12/04/2022
Peer-reviewed
Oui
Volume
79
Number
14
Pages
1340-1351
Language
english
Notes
Publication types: Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
Transcatheter heart valve (THV) dysfunction with an elevated gradient or paravalvular leak (PVL) may be documented late after THV implantation. Medical management, paravalvular plugs, redo THV replacement, or surgical valve replacement may be considered. However, late balloon dilatation is rarely utilized because of concerns about safety or lack of efficacy.
We aimed to evaluate the safety and efficacy of late dilatation in the management of THV dysfunction.
All patients who underwent late dilatation for symptomatic THV dysfunction at 2 institutions between 2016 and 2021 were identified. Baseline, procedural characteristics, and clinical and echocardiographic outcomes were documented. THV frame expansion was assessed by multislice computed tomography before and after late dilatation.
Late dilatation was performed in 30 patients a median of 4.6 months (IQR: 2.3-11.0 months) after THV implantation in the aortic (n = 25; 83.3%), mitral (n = 2; 6.7%), tricuspid (n = 2; 6.7%) and pulmonary (n = 1; 3.3%) position. THV underexpansion was documented at baseline, and frame expansion substantially improved after late dilatation. The mean transvalvular gradient fell in all patients. For aortic THVs specifically, mean transaortic gradient fell from 25.4 ± 13.9 mm Hg to 10.8 ± 4.1 mm Hg; P < 0.001. PVL was reduced to ≤mild in all 11 patients with a previous >mild PVL. Embolic events, stroke, annular injury, and bioprosthetic leaflet injury were not observed. Symptomatic benefit was durable at 19.6 months (IQR: 14.8-36.1 months) follow-up.
Balloon dilatation late after THV implantation appears feasible and safe in appropriately selected patients and may result in THV frame expansion resulting in improvements in hemodynamic performance and PVL.
Keywords
Aortic Valve/surgery, Aortic Valve Stenosis/surgery, Balloon Valvuloplasty/adverse effects, Heart Valve Prosthesis, Humans, Prosthesis Design, Transcatheter Aortic Valve Replacement/adverse effects, Transcatheter Aortic Valve Replacement/methods, Treatment Outcome, balloon dilatation, transcatheter aortic valve replacement, transcatheter heart valve dysfunction, transcatheter mitral valve-in-valve, transcatheter tricuspid valve-in-valve, valvuloplasty
Pubmed
Web of science
Open Access
Yes
Create date
17/01/2025 5:57
Last modification date
24/02/2025 11:34
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