Late Balloon Valvuloplasty for Transcatheter Heart Valve Dysfunction

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Transcatheter heart valve (THV) dysfunction, characterized by elevated gradients or paravalvular leaks (PVL), can occur late after implantation.
• Management options include medical therapy, plugs, or valve replacement, but late balloon dilatation is seldom used due to safety and efficacy concerns.

Purpose of the Study:

• To evaluate the safety and efficacy of late balloon dilatation for managing symptomatic THV dysfunction.

Main Methods:

• A retrospective study identified 30 patients who underwent late dilatation for symptomatic THV dysfunction between 2016 and 2021.
• Data collected included baseline and procedural characteristics, clinical and echocardiographic outcomes.
• Transcatheter heart valve frame expansion was assessed using multislice computed tomography before and after the procedure.

Main Results:

• Late dilatation was performed a median of 4.6 months post-implantation across aortic, mitral, tricuspid, and pulmonary positions.
• Significant THV frame expansion was observed, leading to a substantial reduction in mean transvalvular gradients (e.g., aortic: 25.4 to 10.8 mm Hg).
• Paravalvular leak severity decreased to mild or less in all patients, with no observed embolic events, stroke, or structural injury. Symptomatic improvement was durable.

Conclusions:

• Late balloon dilatation is a feasible and safe intervention for selected patients with transcatheter heart valve dysfunction.
• The procedure effectively expands the THV frame, improving hemodynamic performance and reducing paravalvular leaks.
• This approach offers a potentially valuable option for managing late THV dysfunction.