Double Inflation ("Double Tap") on Valve Expansion and Short-Term Outcomes After the Latest-Generation...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Biomedical Engineering

Background:

• Valve underexpansion and foreshortening impact transcatheter aortic valve replacement (TAVR) outcomes.
• The role of routine postdilatation for the latest SAPIEN 3 Ultra RESILIA (S3UR) valve is not well-established.

Purpose of the Study:

• To evaluate the impact of routine postdilatation on S3UR valve frame expansion and foreshortening.
• To assess short-term clinical outcomes following S3UR TAVR with routine postdilatation.

Main Methods:

• A prospective study included 200 patients undergoing S3UR TAVR with routine postdilatation.
• Valve frame dimensions were measured via fluoroscopy post-deployment and post-postdilatation.
• Expansion and foreshortening were calculated against nominal values; short-term outcomes were tracked for 30 days.

Main Results:

• Routine postdilatation was safe, with no in-hospital adverse events.
• All S3UR valves demonstrated significant underexpansion, particularly at the midframe, which improved post-postdilatation.
• Short-term outcomes included a 1.5% all-cause mortality, 3.0% stroke rate, and no more than mild paravalvular leak.

Conclusions:

• Routine postdilatation of the S3UR valve, when feasible, enhances frame expansion and reduces foreshortening.
• The procedure demonstrated safety and acceptable short-term hemodynamic performance.
• Larger studies are required to confirm these findings and assess long-term impacts.