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Transfemoral aortic valve implantation using a self-expanding transcatheter heart valve without pre-dilation

      Highlights

      • Implantation of the Acurate neo without predilatation is feasible in select patients.
      • Procedure and fluoroscopy time are thereby significantly shorter.
      • The rate of relevant aortic regurgitation or postdilatation is not negatively affected.
      • Hemodynamic stability is maintained throughout the entire procedure.
      • This concept is straightforward and currently represents the gentlest TAVI approach.

      Abstract

      Background

      The aim of the present study was to investigate whether transfemoral implantation of the Acurate neo transcatheter heart valve without pre-dilation is feasible.

      Methods

      Between December 2014 and December 2016, 294 patients were treated with the Acurate neo prosthesis at our center. Of these, 72 cases were performed without pre-dilation. The decision to omit pre-dilation was at the discretion of the operator, preferably in the case of mild to moderate aortic valve calcification (AVC). Propensity matching (1:1) resulted in 48 cases in each group. Main outcomes of interest were device success according to VARC-2 criteria, residual aortic regurgitation (AR) ≥2°, and rate of post-dilation.

      Results

      Median [IQR] age in patients without pre-dilation was 82.7 years [78.6–85.6], STS score was 4.6% [3.4–6.1], and AVC-score was 1436 AU [1043–1682] with mild and moderate AVC in 63.9% and 36.1% of cases, respectively. Device success was achieved in 94.4% of cases, post-dilation was necessary in 26.4%, and one (1.4%) patient had moderate AR. In the matched population, there were no differences regarding device success, rate of AR ≥2°, need for post-dilation, and post-procedural mean gradient, but the group without pre-dilation had shorter procedure (34.0 min [27.0–38.8] vs. 43.0 min [34.3–52.0]; p < 0.001) and fluoroscopy times (7.4 min [5.7–9.0] vs. 9.9 min [7.9–13.5]; p < 0.001).

      Conclusion

      In select patients with mild to moderate AVC, transfemoral implantation of the Acurate neo without pre-dilation is feasible and safe. This allows for a straightforward procedure that may be performed without rapid pacing in the majority of cases.

      Abbreviations:

      AR (aortic regurgitation), AVCS (aortic valve calcium score), AVCdens (aortic valve calcium density), LVOT (left ventricular outflow tract), TAVI (transcatheter aortic valve implantation), MDCT (multidetector computed tomography)

      Keywords

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