Balloon sizing during transcatheter aortic valve implantation : Comparison of different valve morphologies

Although balloon sizing has been found to be useful during transcatheter aortic valve implantation (TAVI), its effectiveness in patients with bicuspid aortic valve (BiAV) remains unknown.

Patients who underwent balloon sizing were retrospectively identified. The study comprised 67 patients (61.2% with BiAV). Preprocedural hypothetical transcatheter heart valve (THV) sizing was based on multislice computed tomography (MSCT) measurements at the annulus. Changes in valve size after balloon sizing were reviewed. Postprocedural MSCT measurements and the grade of paravalvular aortic regurgitation (PAR) were compared.

When comparing patients with a BiAV and those with a tricuspid aortic valve (TiAV), there was no significant difference (p = 0.97) in the proportion of decreased (43.9% vs. 46.2%), unchanged (51.2% vs. 50.0%), or increased (4.9% vs. 3.8%) valve sizes chosen on the basis of MSCT findings. The anticipated annular sizing ratio for patients who received a smaller valve was 7.2% (3.5-10.5%) while it was 15.7% (12.5-19.0) for the others (p < 0.01), and no significant difference in the proportion of mild (or more severe) PAR cases was found between the groups (37.9% vs. 30.6%, p = 0.53 at the 1‑month follow-up). Stent frame expansion and eccentricity index were comparable between the BiAV and TiAV subgroups among patients who received a smaller THV after balloon sizing.

Balloon sizing is a useful tool that is complementary to the current gold standard of MSCT for THV size selection as well as for BiAV morphology assessment.