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

Valve underexpansion and foreshortening play an important role in hemodynamic performance and durability after transcatheter aortic valve replacement. The effect of routine postdilatation of balloon-expandable valves is controversial and unknown with the latest generation SAPIEN 3 Ultra RESILIA (S3UR).

The aim of this study was to report the impact of routine postdilatation of the S3UR on frame expansion, foreshortening and short-term outcomes.

From January 2024 to March 2025, 206 consecutive patients undergoing S3UR transcatheter aortic valve replacement for native aortic stenosis were screened, and 200 patients with routine postdilatation were included, with a median follow-up of 30 days. The valve was predilated in 23% of patients (46 of 200) and postdilated for frame optimization in 100% (200 of 200). Frame dimensions were measured on fluoroscopy at different levels after deployment and after postdilatation. Valve expansion and foreshortening were calculated by comparing observed measurements with expected nominal measurements validated from previous studies.

Routine postdilatation was safe and effective, with no in-hospital adverse events. All S3UR valves were significantly underexpanded, especially at midframe, irrespective of size, and had significant expansion and foreshortening after postdilatation. At 30 days, the rate of all-cause mortality was 1.5% (3 of 200), the rate of stroke was 3.0% (6 of 200), the mean valve gradient was 10.7 ± 4.2 mm Hg, and no patients had greater than mild paravalvular leak.

Routine postdilatation of the latest generation balloon-expandable valve, when clinically and anatomically feasible, appeared safe and improved frame expansion and foreshortening. Larger studies are needed to validate this finding and determine the longer term impact of routine postdilatation, despite acceptable short-term hemodynamic performance.