Balloon post-dilation and valve-in-valve implantation for the reduction of paravalvular leakage with use of the self-expanding CoreValve prosthesis.

AIMS: The aims of the study were to evaluate balloon post-dilation (BPD) and valve-in-valve (ViV) implantation for the reduction of paravalvular leakage (PVL) in patients undergoing transcatheter aortic valve implantation (TAVI) with use of the self-expanding CoreValve prosthesis and to assess whether the aortic regurgitation (AR) index can be used to quantify the reduction of PVL by these corrective measures.

METHODS AND

RESULTS

Angiography and the AR index were used to evaluate the severity of PVL before and after corrective measures in patients suffering from more than mild PVL. Corrective measures were performed in 44.7% (101/226 patients): BPD was performed in 85 patients and ViV implantation in 16 patients, respectively. In 86% (87/101 patients), PVL reduction was successful (no or mild PVL). BPD increased the AR index from 19.1±11.0 to 25.9±5.8 (p<0.001) and ViV implantation from 17.6±6.4 to 29.5±9.1 (p=0.008). One-year mortality (21.6% vs. 17.6% vs. 25.0%; p=0.69) and procedural stroke rate (2.4% vs. 2.4% vs. 0%; p=0.82) were not different between patients without corrective measures compared to patients who had undergone corrective measures (BPD or ViV).

CONCLUSIONS

BPD and ViV implantation are safe and effective to reduce PVL in TAVI patients. The AR index is useful to quantify the success of these corrective measures for PVL reduction objectively.