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Valvular disease

Importance of balloon valvuloplasty before TAVI to prevent embolization

Nature Reviews Cardiology volume 12, page 683 (2015)Cite this article

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Omission of balloon aortic valvuloplasty before implanting a balloon-expandable aortic valve shortens procedure time and lowers contrast volume, but is associated with an increase in cerebral ischaemic lesions. This finding comes from a nonrandomized, single-centre study conducted in Hamburg, Germany.

A total of 87 consecutive, high-risk patients underwent transcatheter aortic valve implantation (TAVI) with a balloon-expandable valve and either received (n = 32) or did not receive (n = 55) prior balloon valvuloplasty. Procedural success was 93.5% and 98.2% in each group, respectively. As expected, the duration of the procedure (69.2 min vs 58.7 min; P = 0.008) and the volume of contrast agent (97.0 ml vs 69.8 ml; P = 0.004) were significantly higher in patients who received balloon valvuloplasty compared with those who did not. However, diffusion-weighted MRI performed 2–7 days after TAVI revealed that patients who did not receive balloon valvuloplasty had a significantly higher volume of cerebral ischaemic lesions (235.5 mm3 vs 89.5 mm3; P = 0.01).

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References

  1. Bijuklic, K. et al. Increased risk of cerebral embolization after implantation of a balloon-expandable aortic valve without prior balloon valvuloplasty. JACC Cardiovasc. Interv. 10.1016/j.jcin.2015.07.013

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Authors
  1. Gregory B. Lim
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Lim, G. Importance of balloon valvuloplasty before TAVI to prevent embolization. Nat Rev Cardiol 12, 683 (2015). https://doi.org/10.1038/nrcardio.2015.160

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