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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