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Late Balloon Valvuloplasty for Transcatheter Heart Valve Dysfunction
Quick Takes
- Late valvuloplasty is safe and feasible among carefully selected patients with transcatheter valve dysfunction due to underexpanded valves.
- There was a significant reduction in mean gradients and paravalvular leak (PVL) with major reported complications.
- Late valvuloplasty can be considered as a treatment option among select patients with elevated gradients or significant PVL and underexpanded transcatheter prosthesis.
Study Questions:
What is the safety and efficacy of late dilatation in the management of transcatheter heart valve (THV) dysfunction?
Methods:
All patients who underwent late dilatation for symptomatic THV dysfunction at two institutions between 2016–2021 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.
Results:
Late dilatation was performed in 30 patients a median of 4.6 months (interquartile range [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. Paravalvular leak (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.
Conclusions:
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.
Perspective:
The study findings show that late valvuloplasty is safe and feasible among select patients with transcatheter valve dysfunction due to underexpanded valves (the majority in the aortic position). As expected, there was a significant reduction in gradients and paravalvular regurgitation post-valvuloplasty. There were minimal complications reported with no occurrence of stroke or annular rupture. Late balloon dilation of THV can be considered in select patients with late THV dysfunction. Whether this approach prevents valve-related complications including leaflet injury and thrombus down the road remains to be determined.
Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and VHD, Interventions and Imaging, Interventions and Structural Heart Disease, Computed Tomography, Echocardiography/Ultrasound, Nuclear Imaging
Keywords: Aortic Valve Stenosis, Balloon Valvuloplasty, Diagnostic Imaging, Dilatation, Echocardiography, Heart Valve Diseases, Heart Valve Prosthesis Implantation, Hemodynamics, Multidetector Computed Tomography, Prostheses and Implants, Stroke, Thrombosis, Transcatheter Aortic Valve Replacement
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