Original Research

DOI: 10.4244/EIJ-D-25-00258

Routine post-dilatation at nominal volume to optimise the expansion of balloon-expandable valves: the DOUBLE-TAP study

Ali Husain1,2, MBBCh; Julius Jelisejevas1,3, MD; Kevin Millar1, MBBCh; Abdulla Alnuwakhtha1, MD; Aaisha Ferkh1, MBBS, PhD; Julien Delarive4, MD; Hacina Gill4, BSc; Jasem Althekrallah1, MD; Sophie Offen1, MBBS; Georgios Tzimas5, MD; Jian Ye1, MD; Jonathon A. Leipsic1, MD; Philipp Blanke1, MD; Janarthanan Sathananthan1, MBChB, MPH; David A. Wood1, MD; Stephanie L. Sellers4, MSc, PhD; David Meier4,5, MD; John G. Webb1, MD

Abstract

Background: Incomplete expansion of balloon-expandable (BE) transcatheter heart valves (THVs) is sometimes treated by ad hoc post-dilatation with an overfilled or larger valvuloplasty balloon. The efficacy of this approach has not been rigorously evaluated, although increased risk for adverse events has been demonstrated. Observational experience suggests that post-dilatation using the original delivery system balloon at the identical filling volume (i.e., double-tap) may routinely improve the degree of THV expansion with low risk.

Aims: We sought to assess the safety and efficacy of a strategy of routine double-tap after BE transcatheter aortic valve implantation (TAVI).

Methods: Patients undergoing TAVI with the SAPIEN 3 Ultra (S3U) valve were prospectively included. Patients with severe annular or subannular calcification were excluded. A validated method of fluoroscopic analysis was utilised to assess the cross-sectional area at the inflow, midpoint, and outflow of the THV before and after double-tap. Thirty-day clinical outcomes were documented.

Results: Routine double-tap was performed in 102 patients. Despite nominal deployment, all patients had some degree of THV underexpansion after the first inflation. Fluoroscopic analysis documented an increase in minimal THV expansion by cross-sectional area of 9.8% for the 20 mm S3U (p=0.151), 9.9% for the 23 mm S3U (p<0.001), 9.2% for the 26 mm S3U (p<0.001), and 8.6% for the 29 mm S3U (p=0.002). There was no stroke or cardiovascular mortality at 30 days.

Conclusions: In favourable anatomy, routine double-tap after BE TAVI improved THV expansion with no safety concerns. The impact of this strategy on THV function, haemodynamic profile, and durability remains to be determined.

Sign in to read
the full article

Forgot your password?
No account yet?
Sign up for free!

Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from PCRonline.com

Volume 21 Number 19
Oct 6, 2025
Volume 21 Number 19
View full issue


Key metrics

Suggested by Cory

Flashlight

10.4244/EIJ-D-24-00204 Aug 19, 2024
Double-tap to treat paravalvular leak in high-risk annuli
Husain A et al
free

Translational research

10.4244/EIJ-D-23-00308 Nov 17, 2023
Redo-TAVI with SAPIEN 3 in SAPIEN XT or SAPIEN 3 – impact of pre- and post-dilatation on final THV expansion
Meier D et al
free

Editorial

10.4244/EIJ-E-23-00009 Apr 24, 2023
SAPIEN 3 Ultra: better sealing, reduced paravalvular leak and a move in the right direction?
Reardon MJ and Goel SS
free

Research Correspondence

10.4244/EIJ-D-24-00741 Mar 3, 2025
Balloon-expandable SAPIEN 3 Ultra valve in intermediate sizing zones: insights from the OPERA-TAVI registry
Costa G et al

Original Research

10.4244/EIJ-D-23-00996 May 10, 2024
Performance and outcomes of the SAPIEN 3 Ultra RESILIA transcatheter heart valve in the OCEAN-TAVI registry
Yamamoto M et al
free
Trending articles
96.55

State-of-the-Art

10.4244/EIJ-D-24-00066 Apr 21, 2025
Management of complications after valvular interventions
Bansal A et al
free
66.9

State-of-the-Art

10.4244/EIJ-D-24-00992 Sep 15, 2025
Antithrombotic therapy in complex percutaneous coronary intervention
Castiello D et al
free
56.6

Original Research

10.4244/EIJ-D-25-00331 May 21, 2025
One-month dual antiplatelet therapy followed by prasugrel monotherapy at a reduced dose: the 4D-ACS randomised trial
Jang Y et al
open access
56.6

Original Research

10.4244/EIJ-D-25-00331 Jul 21, 2025
One-month dual antiplatelet therapy followed by prasugrel monotherapy at a reduced dose: the 4D-ACS randomised trial
Jang Y et al
open access
35.45

State-of-the-Art

10.4244/EIJ-D-23-00448 Jan 15, 2024
Coronary spasm and vasomotor dysfunction as a cause of MINOCA
Yaker ZS et al
free
X

PCR
Impact factor: 9.5
2024 Journal Citation Reports®
Science Edition (Clarivate Analytics, 2025)
Online ISSN 1969-6213 - Print ISSN 1774-024X
© 2005-2025 Europa Group - All rights reserved