Predilation during transcatheter aortic valve replacement (TAVR) and direct TAVR are both safe, effective treatment options for low-risk patients, according to a new analysis published in Circulation: Cardiovascular Interventions. However, the authors noted, direct TAVR is associated with a shorter procedure length.
“In the early phase of TAVR, predilation was considered a fundamental step to fracture the calcified leaflets and create a large enough opening to facilitate crossing of the severely stenotic native valve as well as to optimize the implantation, expansion, and stability of the transcatheter heart valve,” wrote first author Julien Ternacle, MD, PhD, of the Quebec Heart and Lung Institute in Canada. “However, predilation has been associated with complications, including annular injury, stroke, renal failure, conduction disturbances, and paravalvular regurgitation.”
Researchers tracked data from 495 patients with severe symptomatic aortic stenosis who underwent TAVR with the Sapien 3 valve. All patients were treated from March 2016 to October 2017. Nearly 58% of the cohort underwent predilation during TAVR, and the remaining patients underwent direct TAVR.
Overall, the two treatment methods were associated with similar patient outcomes. After 30 days, the study’s primary endpoint—the composite of all-cause death, stroke and rehospitalization—was seen in 3.8% of patients from the predilation group and 4.8% from the direct TAVR. After one year, the rates were 8.7% for the predilation group and 8.1% for the direct TAVR group.
Severe prosthesis-patient mismatch was not common, but did occur more often in the direct TAVR group (8.2% compared to 2.6%). Also, procedure length averaged 63.2 minutes for the predilation group and 51.4 minutes for the direct TAVR group.
The team also emphasized that direct TAVR “was not associated with more intraprocedural complications or increased need for postdilation.”
“These two strategies can be safely performed in selected patients with a low surgical and favorable aortic valve anatomy,” the authors concluded.
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.