Successful management of a foreseeable and preventable complication of transcatheter valve implantation

Özet

The Myval THV is a new balloon expandable valve which has obtained the European Community (CE) mark following the Myval-1 study (1). In this study, 30 patients with severe aortic stenosis (AS) in the medium to high risk group were treated by Myval without major complications such as mortality, paravalvular leakage (PVL), or the need for permanent pacemakers (PPM). These data are similar to the percutaneous arm of the PARTNER-3 trial (2). At the beginning of the transcatheter aortic valve implantation (TAVI) procedure, predilatation was commonly recommended and applied before the implantation of valve. After gaining experience and improvement in valve designs, many operators prefer not to predilate and implant the valve directly; however, there are still no well-defined criteria regarding which valve should be predilatated. We generally consider the degree of calcification, valve area, and mean gradient as important factors to decide whether predilatation is necessary or not. In addition, many studies and personal experiences approve direct TAVI to be as effective and safe as routine TAVI procedures with predilatation (3).