Transcatheter implantation of ballon-expandable valves with ballon underexpansion in patients with borderline aortic valve annulus
Abstract
Background. Recently transcatheter aortic valve implantation (TAVI) has become the optimal choice procedure for patients with aortic stenosis. Last generation of transcatheter valves allows to perform TAVI in a vast majority of patients. Patients with borderline aortic annulus size who have transition of aortic ring parameters (diameter, area and perimeter of ring) from a smaller to a larger size comprise the particular category of patients.
Aim – analysis of TAVI results with use of underexpanded ballon-expandable prosthesis in patients with borderline aortic valve annulus was the aim of this paper.
Material and methods. Among 310 patients who underwent TAVI in 2019 at cardiovascular department of National Cardiology Research Center 38 (12%) patients had borderline aortic valve annulus and they were treated with an underexpansion of ballon-expandable prosthesis approach. Clinico-pathologic profile and hospital outcomes were analyzed.
Results. Mean values of maximal and mean pressure gradient were 88.2±28.3 and 54.4±19.1 mm Hg respectively. Mean area of aortic valve ring was 479.1±88.2 mm2. Mean reduction of volume accounted for 1.9; 2.1 and 2.4 for 23, 26 and 29 sizes respectively. Technical success was 100%. There were no high pressure gradients at 5 day postoperatively with mean values of maximal and mean pressure gradient 19±7,0 and 10±4,0 mm Hg respectively. Complications included 1 major vascular complication (endarterectomy from vascular access site) and 1 case of pacemaker implantation due to atrioventricular block.
Conclusion. Underexpansion of ballon-expandable prosthesis is an effective approach in patients with borderline aortic ring size.
Keywords:transcatheter aortic valve implantation, ballon- expandable prosthesis, “valve-in-valve”
Conflict of interest. The authors declare no conflict of interest.
For citation: Salichkin D.V., Imaev T.E., Komlev A.E., Lepilin P.M., Kolegaev A.S., Makeev M.I., Akchurin R.S. Transcatheter implantation of ballon-expandable valves with ballon underexpansion in patients with borderline aortic valve annulus. Clin Experiment Surg. Petrovsky J. 2020; 8 (2): 17–24. DOI: 10.33029/2308-1198-2020-8-2-17-24 (in Russian)
Received 10.12.2019. Accepted 26.03.2020.
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