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Akodad M, Blanke P, Chuang MYA, Duchscherer J, Sellers SL, Chatfield AG, Gulsin GG, Lauck S, Leipsic JA, Meier D, Moss RR, Cheung A, Sathananthan J, Wood DA, Ye J, Webb JG. Late Balloon Valvuloplasty for Transcatheter Heart Valve Dysfunction. J Am Coll Cardiol 2022; 79:1340-1351. [PMID: 35393014 DOI: 10.1016/j.jacc.2022.01.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/06/2022] [Accepted: 01/18/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Transcatheter heart valve (THV) dysfunction with an elevated gradient or paravalvular leak (PVL) may be documented late after THV implantation. Medical management, paravalvular plugs, redo THV replacement, or surgical valve replacement may be considered. However, late balloon dilatation is rarely utilized because of concerns about safety or lack of efficacy. OBJECTIVES We aimed to evaluate the safety and efficacy of late dilatation in the management of THV dysfunction. METHODS All patients who underwent late dilatation for symptomatic THV dysfunction at 2 institutions between 2016 and 2021 were identified. Baseline, procedural characteristics, and clinical and echocardiographic outcomes were documented. THV frame expansion was assessed by multislice computed tomography before and after late dilatation. RESULTS Late dilatation was performed in 30 patients a median of 4.6 months (IQR: 2.3-11.0 months) after THV implantation in the aortic (n = 25; 83.3%), mitral (n = 2; 6.7%), tricuspid (n = 2; 6.7%) and pulmonary (n = 1; 3.3%) position. THV underexpansion was documented at baseline, and frame expansion substantially improved after late dilatation. The mean transvalvular gradient fell in all patients. For aortic THVs specifically, mean transaortic gradient fell from 25.4 ± 13.9 mm Hg to 10.8 ± 4.1 mm Hg; P < 0.001. PVL was reduced to ≤mild in all 11 patients with a previous >mild PVL. Embolic events, stroke, annular injury, and bioprosthetic leaflet injury were not observed. Symptomatic benefit was durable at 19.6 months (IQR: 14.8-36.1 months) follow-up. CONCLUSIONS Balloon dilatation late after THV implantation appears feasible and safe in appropriately selected patients and may result in THV frame expansion resulting in improvements in hemodynamic performance and PVL.
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Affiliation(s)
- Mariama Akodad
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ming-Yu A Chuang
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jade Duchscherer
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie L Sellers
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Andrew G Chatfield
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Gaurav G Gulsin
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sandra Lauck
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jonathon A Leipsic
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Meier
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Rob R Moss
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Anson Cheung
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Janarthanan Sathananthan
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - David A Wood
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jian Ye
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - John G Webb
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada.
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