Reply: Beyond frame expansion: interpreting the implications of routine post-dilatation

We thank Sturla et al1 for their insight on our manuscript “Routine post-dilatation at nominal volume to optimise the expansion of balloon-expandable valves: the DOUBLE-TAP study”23. We do agree with the authors, that at this time, we do not know whether the improvement in stent frame expansion with the double-tap technique will translate into superior haemodynamics or longer transcatheter heart valve (THV) durability. However, it must be noted that, with current guidelines recommending transcatheter aortic valve implantation in patients as young as 65 years, very long-term durability will be needed, and it remains unclear whether this small increase in expansion might be beneficial. Indeed, our study showed that the double-tap technique was associated with reduced leaflet pinwheeling, which, along with a reduction in turbulent flow, might reduce the risk of hypoattenuated leaflet thickening (HALT) and contribute to valve durability4. This is supported by recent data showing that THV asymmetry was associated with an increase in the HALT rate5.

In this context, the double-tap strategy may be most appealing in patients who are more likely to be...