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DOI: 10.4244/EIJ-D-24-00204

Double-tap to treat paravalvular leak in high-risk annuli

Ali Husain1,2,3, MBBCh; Julius Jelisejevas1,2,3, MD; John King Khoo1,2,3, MBBS; Mariama Akodad4, MD, PhD; Andrew Chatfield1,2,3, MBBS; Fady Zaky1,2,3, MBBS; Stephanie L. Sellers1,2,3,5, MSc, PhD; Jonathon A. Leipsic1,2,3, MD; Philipp Blanke1,2,3, MD; David A. Wood1,2,3, MD; David Meier5,6, MD; Janarthanan Sathananthan1,2,3, MPH, MBChB; John G. Webb1,2,3,5, MD

Post-dilatation (PD) can reduce paravalvular leak (PVL) and improve expansion after transcatheter aortic valve implantation (TAVI) with balloon-expandable valves1, but it can be associated with increased procedural complications, including a higher risk for early stroke and annular injury2. In general, PD is performed with extra volume added to the delivery system balloon or with a non-compliant balloon. The efficacy of PD performed using the same delivery system balloon at the same volume, also referred to as “double-tap”, remains unknown. Here, we highlight a case of successful treatment of PVL using the double-tap technique in the setting of a high-risk annulus.

A 77-year-old female presented with symptomatic severe aortic stenosis. Preprocedural computed tomography showed a type 1 bicuspid valve with moderate to severe raphe calcification and no aortic dilatation.

Surgical risk was high because of the patient’s comorbidities. It was decided to proceed with transfemoral TAVI using a 20 mm SAPIEN 3 Ultra valve (Edwards Lifesciences) at nominal volume with a predicted 2% area oversizing (annular area 324 mm2). A substantial displacement of leaflet calcium was visible during transcatheter heart valve...

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Volume 20 Number 16
Aug 19, 2024
Volume 20 Number 16
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