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Optimizing TAVI strategy: balancing predilatation benefits and direct implantation efficiency
Ahmed Abdalwahab1,2, Abdalazeem Ibrahem3, Mohamed Farag1,3
1Cardiothoracic Department, Freeman Hospital, Newcastle Upon Tyne, UK.
Future Cardiology
|July 23, 2026
Summary
Balloon aortic valvuloplasty (BAV) is shifting from routine use in transcatheter aortic valve implantation (TAVI) to a selective approach. Direct TAVI is safe and effective for most patients, reserving BAV for complex cases.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Balloon aortic valvuloplasty (BAV) was historically integral to transcatheter aortic valve implantation (TAVI).
- Technological advancements in TAVI devices, delivery systems, and imaging have evolved the procedure.
- A shift towards direct TAVI without routine predilatation is emerging.
Purpose of the Study:
- To critically examine the evolving role of BAV in contemporary TAVI practice.
- To evaluate the evidence supporting direct TAVI versus BAV-assisted TAVI.
- To delineate patient selection criteria for predilatation in TAVI.
Main Methods:
- Review of contemporary evidence from randomized trials, large registries, and meta-analyses.
- Analysis of procedural outcomes, device success, and clinical results.
- Assessment of anatomical factors influencing the decision for predilatation.
Main Results:
- Direct TAVI is feasible and safe in anatomically favorable cases, with outcomes comparable to BAV-assisted TAVI.
- Predilatation remains valuable for specific complex anatomies (e.g., calcification, bicuspid valves, challenging crossing).
- Routine BAV may increase procedural risks and resource utilization.
Conclusions:
- Current evidence supports a selective, anatomy-driven approach to predilatation in TAVI.
- The decision for BAV should balance procedural efficiency with optimal valve deployment and patient safety.
- This approach optimizes outcomes in the evolving landscape of TAVI procedures.