Is postdilatation useful after implantation of the Edwards valve?

Yusuke Watanabe, Kentaro Hayashida, Thierry Lefèvre, Mauro Romano, Thomas Hovasse, Bernard Chevalier, Philippe Garot, Patrick Donzeau-Gouge, Arnaud Farge, Erik Bouvier, Bertrand Cormier, Marie Claude Morice

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Few data are available about postdilatation (PD) for the treatment of significant paravalvular aortic regurgitation (AR) after transcatheter aortic valve implantation of the Edwards valve. Methods and Results: A total of 470 patients, aged 83.4 ± 6.4 yrs, with logistic European System for Cardiac Operative Risk Evaluation 21.9 ± 12.3, undergoing transcatheter aortic valve implantation with the Edwards valve were evaluated. PD was performed using the balloon delivery system when significant paravalvular AR was identified. The diameter of the valve was measured from cine acquisition at three different levels. PD was performed in 49 (10.4%) patients with grade 2, 3, or 4 AR as 42.1%, 55.3%, and 2.6%, respectively. After PD, a reduction of at least 1 degree of AR was achieved in 81.5% of cases. Residual AR grades 2, 3, and 4 were observed in 36.8%, 10.5%, and 0%, respectively. A significant increase in the prosthesis diameter was observed at the three valve levels (absolute Δ 3.5%-5.4%, P.< 0.01). For the 23 mm valve, mid level of valve increased from 23.0 ± 0.4 to 24.1 ± 0.5 mm (P < 0.01) and for the 26 mm, from 25.2 ± 0.9 to 26.6 ± 0.9 mm (P < 0.01). Occurrence of annulus rupture (4.1% vs. 1.7%, P = 0.24), cerebrovascular accidents (2.0% vs. 2.1%, P = 0.72), need for new pacemaker (8.2% vs. 5.5%, P = 0.31), and 30-day composite endpoint (24.5% vs. 20.2%, P = 0.48) were not significantly different between PD and non-PD groups. Conclusions: PD for the treatment of significant paravalvular leak proved to be a feasible treatment allowing a significant increase in valve size and decrease in PVL without increase in stroke rates. This promising approach needs further confirmation.

Original languageEnglish
Pages (from-to)667-676
Number of pages10
JournalCatheterization and Cardiovascular Interventions
Volume85
Issue number4
DOIs
Publication statusPublished - 2015 Mar 1
Externally publishedYes

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Aortic Valve Insufficiency
Stroke
Prostheses and Implants
Rupture
Therapeutics

Keywords

  • Edwards valve
  • Postdilatation
  • Transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Watanabe, Y., Hayashida, K., Lefèvre, T., Romano, M., Hovasse, T., Chevalier, B., ... Morice, M. C. (2015). Is postdilatation useful after implantation of the Edwards valve? Catheterization and Cardiovascular Interventions, 85(4), 667-676. https://doi.org/10.1002/ccd.25486

Is postdilatation useful after implantation of the Edwards valve? / Watanabe, Yusuke; Hayashida, Kentaro; Lefèvre, Thierry; Romano, Mauro; Hovasse, Thomas; Chevalier, Bernard; Garot, Philippe; Donzeau-Gouge, Patrick; Farge, Arnaud; Bouvier, Erik; Cormier, Bertrand; Morice, Marie Claude.

In: Catheterization and Cardiovascular Interventions, Vol. 85, No. 4, 01.03.2015, p. 667-676.

Research output: Contribution to journalArticle

Watanabe, Y, Hayashida, K, Lefèvre, T, Romano, M, Hovasse, T, Chevalier, B, Garot, P, Donzeau-Gouge, P, Farge, A, Bouvier, E, Cormier, B & Morice, MC 2015, 'Is postdilatation useful after implantation of the Edwards valve?', Catheterization and Cardiovascular Interventions, vol. 85, no. 4, pp. 667-676. https://doi.org/10.1002/ccd.25486
Watanabe Y, Hayashida K, Lefèvre T, Romano M, Hovasse T, Chevalier B et al. Is postdilatation useful after implantation of the Edwards valve? Catheterization and Cardiovascular Interventions. 2015 Mar 1;85(4):667-676. https://doi.org/10.1002/ccd.25486
Watanabe, Yusuke ; Hayashida, Kentaro ; Lefèvre, Thierry ; Romano, Mauro ; Hovasse, Thomas ; Chevalier, Bernard ; Garot, Philippe ; Donzeau-Gouge, Patrick ; Farge, Arnaud ; Bouvier, Erik ; Cormier, Bertrand ; Morice, Marie Claude. / Is postdilatation useful after implantation of the Edwards valve?. In: Catheterization and Cardiovascular Interventions. 2015 ; Vol. 85, No. 4. pp. 667-676.
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AU - Hovasse, Thomas

AU - Chevalier, Bernard

AU - Garot, Philippe

AU - Donzeau-Gouge, Patrick

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AU - Cormier, Bertrand

AU - Morice, Marie Claude

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N2 - Background: Few data are available about postdilatation (PD) for the treatment of significant paravalvular aortic regurgitation (AR) after transcatheter aortic valve implantation of the Edwards valve. Methods and Results: A total of 470 patients, aged 83.4 ± 6.4 yrs, with logistic European System for Cardiac Operative Risk Evaluation 21.9 ± 12.3, undergoing transcatheter aortic valve implantation with the Edwards valve were evaluated. PD was performed using the balloon delivery system when significant paravalvular AR was identified. The diameter of the valve was measured from cine acquisition at three different levels. PD was performed in 49 (10.4%) patients with grade 2, 3, or 4 AR as 42.1%, 55.3%, and 2.6%, respectively. After PD, a reduction of at least 1 degree of AR was achieved in 81.5% of cases. Residual AR grades 2, 3, and 4 were observed in 36.8%, 10.5%, and 0%, respectively. A significant increase in the prosthesis diameter was observed at the three valve levels (absolute Δ 3.5%-5.4%, P.< 0.01). For the 23 mm valve, mid level of valve increased from 23.0 ± 0.4 to 24.1 ± 0.5 mm (P < 0.01) and for the 26 mm, from 25.2 ± 0.9 to 26.6 ± 0.9 mm (P < 0.01). Occurrence of annulus rupture (4.1% vs. 1.7%, P = 0.24), cerebrovascular accidents (2.0% vs. 2.1%, P = 0.72), need for new pacemaker (8.2% vs. 5.5%, P = 0.31), and 30-day composite endpoint (24.5% vs. 20.2%, P = 0.48) were not significantly different between PD and non-PD groups. Conclusions: PD for the treatment of significant paravalvular leak proved to be a feasible treatment allowing a significant increase in valve size and decrease in PVL without increase in stroke rates. This promising approach needs further confirmation.

AB - Background: Few data are available about postdilatation (PD) for the treatment of significant paravalvular aortic regurgitation (AR) after transcatheter aortic valve implantation of the Edwards valve. Methods and Results: A total of 470 patients, aged 83.4 ± 6.4 yrs, with logistic European System for Cardiac Operative Risk Evaluation 21.9 ± 12.3, undergoing transcatheter aortic valve implantation with the Edwards valve were evaluated. PD was performed using the balloon delivery system when significant paravalvular AR was identified. The diameter of the valve was measured from cine acquisition at three different levels. PD was performed in 49 (10.4%) patients with grade 2, 3, or 4 AR as 42.1%, 55.3%, and 2.6%, respectively. After PD, a reduction of at least 1 degree of AR was achieved in 81.5% of cases. Residual AR grades 2, 3, and 4 were observed in 36.8%, 10.5%, and 0%, respectively. A significant increase in the prosthesis diameter was observed at the three valve levels (absolute Δ 3.5%-5.4%, P.< 0.01). For the 23 mm valve, mid level of valve increased from 23.0 ± 0.4 to 24.1 ± 0.5 mm (P < 0.01) and for the 26 mm, from 25.2 ± 0.9 to 26.6 ± 0.9 mm (P < 0.01). Occurrence of annulus rupture (4.1% vs. 1.7%, P = 0.24), cerebrovascular accidents (2.0% vs. 2.1%, P = 0.72), need for new pacemaker (8.2% vs. 5.5%, P = 0.31), and 30-day composite endpoint (24.5% vs. 20.2%, P = 0.48) were not significantly different between PD and non-PD groups. Conclusions: PD for the treatment of significant paravalvular leak proved to be a feasible treatment allowing a significant increase in valve size and decrease in PVL without increase in stroke rates. This promising approach needs further confirmation.

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