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BioMed Research International
Volume 2018, Article ID 1080597, 6 pages
Research Article

Aortic Valve Predilatation with a Small Balloon, without Rapid Pacing, prior to Transfemoral Transcatheter Aortic Valve Replacement

1Deutsches Herzzentrum München, Department for Cardiovascular Diseases, Technische Universität München, Lazarettstr. 36, 80636 Munich, Germany
2Department of Cardiology, Advocate Christ Medical Center, 4440 W. 95th Street, Oak Lawn, IL, USA
3Department of Cardiology, Klinikum Augsburg, Herzzentrum Augsburg-Schwaben, Stenglinstr. 2, 86156 Augsburg, Germany
4Deutsches Zentrum für Herz- und Kreislaufforschung (DZHK), Munich Heart Alliance, Munich, Germany

Correspondence should be addressed to Albert Markus Kasel; ed.bew@lesak_sukram

Received 16 July 2017; Revised 28 February 2018; Accepted 14 March 2018; Published 30 April 2018

Academic Editor: Giovanni Mariscalco

Copyright © 2018 Anupama Shivaraju et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objectives. The aim of this study is to assess the feasibility and clinical outcome of transcatheter aortic valve replacement (TAVR) using aortic valve predilatation (AVPD) with a small, nonocclusive balloon. Background. Balloon aortic valvuloplasty (BAV) under rapid pacing is generally performed in TAVR to ensure the passage and sufficient deployment of the prosthesis in the stenotic AV. BAV may cause serious complications, such as left ventricular stunning or cerebrovascular embolism. Methods. A cohort of 50 consecutive patients with severe aortic stenosis underwent transfemoral TAVR with the Edwards Sapien 3-heart valve. All patients underwent AVPD with a small, nonocclusive balloon (12 × 60 or 14 × 60 mm) without rapid pacing. Procedural data and clinical outcomes were analyzed. Results. The mean age of the cohort was years and the mean logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) was . Crossing the AV and prosthesis implantation was successful in all cases. The postprocedural mean AV gradient was  mmHg. There were no cases of aortic regurgitation ≥ grade 2. No periprocedural stroke occurred. One patient (2%) with chronic atrial fibrillation displayed a transient Wernicke aphasia occurring more than 24 hours after TAVR. Mortality was 0% at 30 days after procedure. Conclusion. In TAVR, AVPD with a small, nonocclusive balloon can be safely performed. By avoiding rapid pacing, this technique may be a valid alternative to traditional BAV. Whether or not the use of APVD without rapid pacing translates into less periprocedural complications needs to be assessed in future studies.