TAV-in-SAV procedural tips and tricks: balloon predilatation

Transcatheter aortic valve implantation within failing surgical aortic bioprostheses

Is it ever appropriate to use balloon valvuloplasty in a TAV-in-SAV procedure? This section looks at the current guidelines for balloon valvuloplasty and discusses the dangers involved. Examine why and when there can be significant risks of haemodynamic compromise. Understand which conditions, such as suboptimal THV expansion, might encourage the use of balloon valvuloplasty and why, even in this situation, other alternatives might produce better results.

Current guidelines discourage balloon valvuloplasty of degenerative bioprostheses on the left side of the heart as a single procedure because of a significant risk of haemodynamic compromise following inadvertent leaflet tear1,2. Certainly, there is little to be gained from pre-emptive balloon valvuloplasty in the setting of primary bioprosthesis regurgitation or in transapical cases with antegrade crossing of the aortic valve. In contrast, if difficulty crossing a stenotic bioprosthesis or if suboptimal THV expansion is envisaged due to severe calcification or pannus formation, then upfront valvuloplasty with an undersized balloon may be appropriate.