Just tap it in... stent optimisation in TAVI

Traditionally, balloon post-dilatation following transcatheter aortic valve implantation (TAVI) was routinely performed to address paravalvular leak (PVL), clearly malexpanded valves with residual gradients, and occasionally, as a salvage manoeuvre for deeply implanted transcatheter heart valves (THV). The advent of computed tomographic sizing, external anti-PVL skirts, repositionable device technology, and increasing operator experience has more recently rendered routine post-dilatation less common: it is performed in approximately 20% of cases1, with lower rates for balloon-expandable valves (BEV)2. What are the potential drawbacks of post-dilatation? These include exposing the patient to an additional pacing run, increased procedural and fluoroscopic times, the cost of a balloon, and potential damage to the valve leaflets. Bench studies have shown that post-dilatation can leave an imprint of the THV frame on leaflet tissue, suggesting possible compromise of leaflet integrity3. The risk of THV embolisation, a disagreeable complication for both patient and operator, is often cited as a reason to avoid post-dilatation, especially with high implantation. And then, there are observational data that associate post-dilatation with higher rates of stroke and death45. These...