Pre-implantation balloon-aortic valvuloplasty before transcatheter aortic valve implantation: is this still needed?

Rafail A Kotronias; Michael Teitelbaum; Rodrigo Bagur

doi:10.21037/jtd.2018.06.102

Pre-implantation balloon-aortic valvuloplasty before transcatheter aortic valve implantation: is this still needed?

J Thorac Dis. 2018 Nov;10(Suppl 30):S3599-S3603. doi: 10.21037/jtd.2018.06.102.

Authors

Rafail A Kotronias^{1

2

3}, Michael Teitelbaum⁴, Rodrigo Bagur^{3

4}

Affiliations

¹ Oxford University Clinical Academic Graduate School, University of Oxford, Oxford, UK.
² Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
³ Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK.
⁴ London Health Sciences Centre, Western University, London, Ontario, Canada.

Abstract

Balloon aortic valvuloplasty (BAV) has historically been recommended prior to transcatheter aortic valve implantation (TAVI). Pre-implantation BAV (pBAV) creates fractures at the level of calcified leaflets, thereby facilitating delivery of the transcatheter valve system across the diseased aortic valve and, enhances prosthesis implantation and expansion within the calcified aortic valve annulus. New device designs, lower profile delivery systems and increasing operator experience have enabled direct-TAVI (without pBAV), and its appeal amongst TAVI operators enhanced the dissemination of a direct TAVI approach across many centres. In this review, we discuss contemporary evidence that inform the debate on the need for routine pBAV for TAVI candidates and present a framework that may assist operators in selecting patients for pBAV.

Keywords: Transcatheter aortic valve implantation (TAVI); balloon aortic valvuloplasty (BAV); direct implantation; transcatheter aortic valve replacement (TAVR).

Publication types

Review