Routine postdilation after 23 mm Sapien 3 Ultra implantation in the aortic position.

Area of Science:

• Cardiovascular Interventions
• Medical Devices
• Hemodynamics

Background:

• Residual transprosthetic gradient (TG) after transcatheter aortic valve replacement (TAVR) using balloon-expandable valves (BEV) may stem from incomplete valve expansion.
• Optimizing valve deployment is crucial for favorable post-procedural hemodynamics.

Purpose of the Study:

• To compare hemodynamic outcomes in patients undergoing TAVR with small BEV, stratified by postdilation strategy.
• To evaluate the impact of routine postdilation versus standard practice on transprosthetic gradient and prosthesis-patient mismatch.

Main Methods:

• Retrospective cohort study of 184 patients receiving 23 mm Sapien 3 Ultra BEV.
• Comparison of routine postdilation (RP, n=73) versus standard practice (SP, n=111) groups.
• Primary endpoint: 30-day mean TG; Secondary endpoints: 30-day prosthesis-patient mismatch (PPM), technical and device success.

Main Results:

• Routine postdilation (RP) was associated with a lower 30-day mean TG (12.3 ± 4.6 mmHg) compared to standard practice (SP) (14.1 ± 5.7 mmHg; p=0.031).
• Incidence of 30-day PPM was significantly lower in the RP group (47.3%) versus the SP group (71.0%; p=0.006).
• Final BEV width was a significant predictor of 30-day mean TG (r=-0.6654, p<0.0001).

Conclusions:

• Routine postdilation following TAVR with small BEV is linked to improved forward-flow hemodynamics.
• This strategy effectively reduces residual transprosthetic gradient and the occurrence of prosthesis-patient mismatch.
• Optimizing BEV expansion through routine postdilation enhances hemodynamic performance.