SpringerLink
Log in

Balloon sizing during transcatheter aortic valve implantation

Comparison of different valve morphologies

Ballonbasierte Klappengrößenbestimmung bei Transkatheter-Aortenklappenimplantation

Vergleich verschiedener Klappenmorphologien

  • Original articles
  • Published:
Herz Aims and scope Submit manuscript

Abstract

Background

Although balloon sizing has been found to be useful during transcatheter aortic valve implantation (TAVI), its effectiveness in patients with bicuspid aortic valve (BiAV) remains unknown.

Methods

Patients who underwent balloon sizing were retrospectively identified. The study comprised 67 patients (61.2% with BiAV). Preprocedural hypothetical transcatheter heart valve (THV) sizing was based on multislice computed tomography (MSCT) measurements at the annulus. Changes in valve size after balloon sizing were reviewed. Postprocedural MSCT measurements and the grade of paravalvular aortic regurgitation (PAR) were compared.

Results

When comparing patients with a BiAV and those with a tricuspid aortic valve (TiAV), there was no significant difference (p = 0.97) in the proportion of decreased (43.9% vs. 46.2%), unchanged (51.2% vs. 50.0%), or increased (4.9% vs. 3.8%) valve sizes chosen on the basis of MSCT findings. The anticipated annular sizing ratio for patients who received a smaller valve was 7.2% (3.5–10.5%) while it was 15.7% (12.5–19.0) for the others (p < 0.01), and no significant difference in the proportion of mild (or more severe) PAR cases was found between the groups (37.9% vs. 30.6%, p = 0.53 at the 1‑month follow-up). Stent frame expansion and eccentricity index were comparable between the BiAV and TiAV subgroups among patients who received a smaller THV after balloon sizing.

Conclusion

Balloon sizing is a useful tool that is complementary to the current gold standard of MSCT for THV size selection as well as for BiAV morphology assessment.

Zusammenfassung

Hintergrund

Die ballonbasierte Größenbestimmung der Herzklappe wurde zwar als nützlich bei der Transkatheter-Aortenklappenimplantation (TAVI) erachtet, aber ihre Wirksamkeit bei Patienten mit bikuspider Aortenklappe (BiAV) ist bisher nicht bekannt.

Methoden

Retrospektiv wurden Patienten mit ballonbasierter Größenbestimmung der Klappe ermittelt. Die Studie umfasste 67 Patienten (61,2 % mit BiAV). Die präprozedurale hypothetische Transkatheter-Herzklappen(THV)-Größenbestimmung basierte auf Messungen mittels Multislice-Computertomographie (MSCT) am Anulus. Betrachtet wurden Veränderungen der Klappengröße nach ballonbasierter Größenbestimmung. Postprozedurale MSCT-Messungen und der Grad der paravalvulären Aortenregurgitation (PAR) wurden verglichen.

Ergebnisse

Beim Vergleich von Patienten mit BiAV und Patienten mit trikuspidaler Aortenklappe (TiAV) gab es keinen signifikanten Unterschied (p = 0,97) in Bezug auf den Anteil verminderter (43,9 vs. 46,2 %), unveränderter (51,2 vs. 50,0 %) oder erhöhter (4,9 vs. 3,8 %) Klappengrößen, die auf der Grundlage der MSCT-Befunde ausgewählt worden waren. Das antizipierte Größenverhältnis zum Anulus für Patienten, die eine kleinere Klappe erhielten, betrug 7,2 % (3,5–10,5 %), während es für die anderen bei 15,7 % (12,5–19,0) lag (p < 0,01), dabei bestand kein signifikanter Unterschied in Bezug auf den Anteil leichtgradiger (oder schwerer) PAR-Fälle zwischen den Gruppen (37,9 vs. 30,6 %; p = 0,53 beim 1‑Monats-Follow-up). Die Expansion des Stents und der Ekzentrizitätsindex waren zwischen den BiAV- und TiAV-Subgruppen bei Patienten, die eine kleinere THV nach ballonbasierter Größenbestimmung erhielten, vergleichbar.

Schlussfolgerung

Die ballonbasierte Größenbestimmung der Herzklappe ist ein nützliches Verfahren, das den derzeitigen Goldstandard der MSCT ergänzt in Bezug auf die Auswahl der Größe einer THV sowie der Morphologie einer BiAV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Serfaty JM, Himbert D, Esposito-Farese M et al (2014) Measurement of the aortic annulus diameter using transesophageal echocardiography and multislice computed tomography—are they truly comparable? Can J Cardiol 30:1073–1079. https://doi.org/10.1016/j.cjca.2014.06.012

    Article  Google Scholar 

  2. Barbanti M, Yang T‑H, Rodes Cabau J et al (2013) Anatomical and procedural features associated with aortic root rupture during balloon-expandable transcatheter aortic valve replacement. Circulation 128:244–253. https://doi.org/10.1161/CIRCULATIONAHA.113.002947

    Article  PubMed  Google Scholar 

  3. Gilard M, Eltchaninoff H, Iung B et al (2012) Registry of transcatheter aortic-valve implantation in high-risk patients. N Engl J Med 366:1705–1715. https://doi.org/10.1056/NEJMoa1114705

    Article  CAS  PubMed  Google Scholar 

  4. Babaliaros V (2013) To size or not to size—there is no question: balloon sizing for transcatheter aortic valve replacement. JACC Cardiovasc Interv 6:972–973. https://doi.org/10.1016/j.jcin.2013.06.005

    Article  PubMed  Google Scholar 

  5. Jilaihawi H, Wu Y, Yang Y et al (2015) Morphological characteristics of severe aortic stenosis in China: imaging corelab observations from the first Chinese transcatheter aortic valve trial. Catheter Cardiovasc Interv 1:752–761. https://doi.org/10.1002/ccd.25863

    Article  Google Scholar 

  6. Grube E, Laborde JC, Gerckens U et al (2006) Percutaneous implantation of the CoreValve self-expanding valve prosthesis in high-risk patients with aortic valve disease: the Siegburg first-in-man study. Circulation 114:1616–1624. https://doi.org/10.1161/CIRCULATIONAHA.106.639450

    Article  PubMed  Google Scholar 

  7. Petronio AS, De Carlo M, Bedogni F et al (2010) Safety and efficacy of the subclavian approach for transcatheter aortic valve implantation with the CoreValve revalving system. Circ Cardiovasc Interv 3:359–366. https://doi.org/10.1161/CIRCINTERVENTIONS.109.930453

    Article  PubMed  Google Scholar 

  8. Kappetein AP, Head SJ, Genereux P et al (2012) Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. Eur J Cardiothorac Surg 8:782–795. https://doi.org/10.4244/EIJV8I7A121

    Article  Google Scholar 

  9. Guo Y, Yang Z, Shao H et al (2013) Right ventricular dysfunction and dilatation in patients with mitral regurgitation: analysis using ECG-gated multidetector row computed tomography. Int J Cardiol 167:1585–1590. https://doi.org/10.1016/j.ijcard.2012.04.104

    Article  PubMed  Google Scholar 

  10. Cerillo AG, Mariani M, Berti S, Glauber M (2012) Sizing the aortic annulus. Ann Cardiothorac Surg 1:245–256. https://doi.org/10.3978/j.issn.2225-319X.2012.06.13

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kasel AM, Cassese S, Bleiziffer S et al (2013) Standardized imaging for aortic annular sizing: implications for transcatheter valve selection. JACC Cardiovasc Imaging 6:249–262. https://doi.org/10.1016/j.jcmg.2012.12.005

    Article  PubMed  Google Scholar 

  12. Patsalis PC, Al-Rashid F, Neumann T et al (2013) Preparatory balloon aortic valvuloplasty during transcatheter aortic valve implantation for improved valve sizing. JACC Cardiovasc Interv. https://doi.org/10.1016/j.jcin.2013.05.006

    Article  PubMed  Google Scholar 

  13. Oh JK, Little SH, Abdelmoneim SS et al (2015) Regression of Paravalvular aortic regurgitation and remodeling of self-expanding transcatheter aortic valve: an observation from the corevalve U.S. Pivotal trial. J Am Coll Cardiol Img. https://doi.org/10.1016/j.jcmg.2015.07.012

    Article  Google Scholar 

  14. Schultz CJ, Weustink A, Piazza N et al (2009) Geometry and degree of apposition of the CoreValve ReValving system with multislice computed tomography after implantation in patients with aortic stenosis. J Am Coll Cardiol 54:911–918. https://doi.org/10.1016/j.jacc.2009.04.075

    Article  PubMed  Google Scholar 

  15. Kazuno Y, Maeno Y, Kawamori H et al (2016) Comparison of SAPIEN 3 and SAPIEN XT transcatheter heart valve stent-frame expansion: evaluation using multi-slice computed tomography. Eur Heart J Cardiovasc Imaging. https://doi.org/10.1093/ehjci/jew032

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hayashida K, Lefevre T, Chevalier B et al (2012) Impact of post-procedural aortic regurgitation on mortality after transcatheter aortic valve implantation. JACC Cardiovasc Interv 5:1247–1256. https://doi.org/10.1016/j.jcin.2012.09.003

    Article  PubMed  Google Scholar 

  17. Jilaihawi H, Chen M, Webb J et al (2016) A bicuspid aortic valve imaging classification for the TAVR era. Jacc Cardiovasc Imaging. https://doi.org/10.1016/j.jcmg.2015.12.022

    Article  PubMed  Google Scholar 

  18. Zegdi R, Ciobotaru V, Noghin M et al (2008) Is it reasonable to treat all calcified stenotic aortic valves with a valved stent? Results from a human anatomic study in adults. J Am Coll Cardiol 51:579–584. https://doi.org/10.1016/j.jacc.2007.10.023

    Article  PubMed  Google Scholar 

  19. Lewin MB, Otto CM (2005) The bicuspid aortic valve: adverse outcomes from infancy to old age. Circulation 111:832–834. https://doi.org/10.1161/01.CIR.0000157137.59691.0B

    Article  PubMed  Google Scholar 

  20. Kochman J, Rymuza B, Huczek Z (2015) Transcatheter aortic valve replacement in bicuspid aortic valve disease. Curr Opin Cardiol 30:594–602. https://doi.org/10.1097/HCO.0000000000000219

    Article  PubMed  Google Scholar 

  21. Babaliaros VC, Junagadhwalla Z, Lerakis S et al (2010) Use of balloon aortic valvuloplasty to size the aortic annulus before implantation of a balloon-expandable transcatheter heart valve. JACC Cardiovasc Interv 3:114–118. https://doi.org/10.1016/j.jcin.2009.09.017

    Article  PubMed  Google Scholar 

  22. Popma JJ, Gleason TG, Yakubov SJ et al (2016) Relationship of annular sizing using multidetector computed tomographic imaging and clinical outcomes after self-expanding corevalve transcatheter aortic valve replacement. Circ Cardiovasc Interv. https://doi.org/10.1161/CIRCINTERVENTIONS.115.003282

    Article  PubMed  Google Scholar 

  23. Jilaihawi H, Chin D, Spyt T et al (2011) Comparison of complete versus incomplete stent frame expansion after transcatheter aortic valve implantation with Medtronic CoreValve bioprosthesis. Am J Cardiol 107:1830–1837. https://doi.org/10.1016/j.amjcard.2011.02.317

    Article  PubMed  Google Scholar 

  24. Rodriguez-Olivares R, Rahhab Z, Faquir NE et al (2016) Differences in frame geometry between balloon-expandable and self-expanding transcatheter heart valves and association with aortic regurgitation. Rev Espanola Cardiol 69:392–400. https://doi.org/10.1016/j.rec.2015.08.010

    Article  Google Scholar 

  25. Mendiz OA, Fraguas H, Lev GA et al (2013) Transcatheter aortic valve implantation without balloon predilation: a single-center pilot experience. Catheter Cardiovasc Interv 82:292–297. https://doi.org/10.1002/ccd.24805

    Article  PubMed  Google Scholar 

  26. Pagnesi M, Jabbour RJ, Latib A et al (2016) Usefulness of predilation before transcatheter aortic valve implantation. Am J Cardiol 118:107–112. https://doi.org/10.1016/j.amjcard.2016.04.018

    Article  PubMed  Google Scholar 

Download references

Funding

This work was supported by National Natural Science Foundation of China (81370219, Bei**g, China); Science and Technology Support Plan of Sichuan province (2016FZ0078); Science and Technology Innovative Research Groups Program of Sichuan province (2017TD0004); “13th Five-Year” National key Research and Development Program of China (2016YFC1102200); West China Hospital “1·3·5” Discipline of Excellence Project-Percutaneous transcatheter aortic valve implantation.

Author information

Authors and Affiliations

  1. Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Alley, 610041, Chengdu, China

    Y.-N. Xu MD, T.-Y. **ong MD, Y.-J. Li MD, Y.-B. Liao MD, Z.-G. Zhao MD, X. Wei MD, Y. Feng MD & M. Chen MD, PhD

Authors
  1. Y.-N. Xu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T.-Y. **ong MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y.-J. Li MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Y.-B. Liao MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Z.-G. Zhao MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. X. Wei MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Y. Feng MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M. Chen MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Chen MD, PhD.

Ethics declarations

Conflict of interest

Y. Feng and M. Chen are consultants/proctors of Venus MedTech. Y.-N. Xu, T.-Y. **ong, Y.-J. Li, Y.-B. Liao, Z.-G. Zhao, and X. Wei declare that they have no competing interests.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Additional information

Yuan-Ning Xu and Tian-Yuan **ong contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xu, YN., **ong, TY., Li, YJ. et al. Balloon sizing during transcatheter aortic valve implantation. Herz 45, 192–198 (2020). https://doi.org/10.1007/s00059-018-4714-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00059-018-4714-2

Keywords

Schlüsselwörter

Search

Navigation