Determinants of success and hemodynamic impact of balloon postdilatation of self‐expanding transcatheter aortic valves

Objectives To explore the rate, the determinants of success, and the hemodynamic impact of balloon postdilatation (BPD) of self‐expanding transcatheter heart valves (SE‐THVs) Background BPD is commonly used to optimize valve expansion and reduce paravalvular leakage (PVL) after transcatheter aortic valve implantation (TAVI) without clearly knowing its hemodynamic benefits. Methods Patients ( n = 307) who received a SE‐THV were stratified according to whether a BPD was performed or not. Patients who received BPD were stratified according to the severity of PVL remaining after BPD into two groups: Successful BPD (≤mild PVL + BPD) and Failed BPD (moderate‐severe PVL + BPD). Results BPD was performed in 121 patients (39.4%) and was successful in 106 patients (87.6% of attempts). A ratio of the postdilatation balloon diameter to the annulus diameter ≤0.95 was an independent predictor of BPD failure (OR: 10.72 [2.02‐56.76], P = .005). Peak transvalvular pressure gradient (PG) was lower in the Successful BPD group (14[12‐22] mm Hg) than in the Failed BPD group (18[16‐23] mm Hg, P = .029), and did not rise in either group during follow‐up (median [IQR], 364[161‐739] days). Conclusion BPD was performed in 39% of patients who received a SE‐THV, and was successful in the majority of attempts. BPD failure was more likely in patients with a small postdilatation balloon‐to‐annulus diameter ratio. Effective BPD improved THV hemodynamic performance, and this was maintained in the intermediate‐term post‐TAVI.