Balloon Postdilation After Transcatheter Aortic Valve Implantation (TAVI) Among Self- and Balloon-Expandable Valves: A Systematic Review and Meta-Analysis.

Balloon postdilation (BPD) is used to optimize valve expansion after transcatheter aortic valve implantation (TAVI). However, the clinical impact, particularly between balloon-expandable (BE) and self-expanding (SE) valves, remains unclear. We conducted a systematic search of PubMed, Embase, and Cochrane Library to compare patients undergoing TAVI with and without BPD. We pooled the risk ratios (RR) and mean differences (MD) for binary and continuous outcomes, respectively. All statistical analyses were performed using a random effects model. Sixteen observational studies comprising 15,508 patients were included, of which 3,397 (22%) underwent TAVI with BPD. BPD was associated with a significantly higher risk of in-hospital stroke (RR, 1.66; 95% CI 1.15 to 2.40; p <0.01) and 30-day mortality (RR, 1.28; 95% CI 1.05 to 1.56; p = 0.01). No significant differences were observed in terms of 30-day, 1-year, or overall stroke; pacemaker implantation; myocardial infarction; or cardiovascular or all-cause mortality. Regarding echocardiographic outcomes, BPD resulted in a larger effective orifice area (EOA) (MD 0.06; 95% CI 0.01 to 0.11; p = 0.01), with no differences in the mean transvalvular gradient and paravalvular regurgitation. In prespecified subgroup analyses, BPD was associated with an increased risk of 1-year stroke in patients receiving BE valves (RR, 1.57; 95% CI, 1.11 to 2.24; p = 0.01) and a higher 30-day mortality with SE valves (RR, 1.28; 95% CI 1.01 to 1.62; p = 0.04) compared with non-BPD. BPD is associated with an increased risk of early mortality and periprocedural stroke, albeit with a slightly larger EOA. Further randomized trials are needed to confirm our findings.