Scarcity of data is available regarding adequate choice of the postdilatation balloon size in TAVI. Hereby, we demonstrate the value of CT scan to choose accurately the post dilatation balloon size.

From November 2007 to December 2011, 384 patients underwent TAVI in our center [233 Edwards and 151 CoreValve]. 74 were treated with post dilatation for residual AR following valve implantation. In this study, 68 were analyzed after excluding 6 patients due to unavailable data.

Mean age was 79±6.2 yrs. Male gender was 42 (61.7%). Mean logistic Euroscore and STS score were 25.2±17.3 and 9.1±9.1, respectively. Mean grades of aortic regurgitation at baseline, before and after post dilatation were 1.3±1.1, 2.3±0.7 and 0.8±0.6, respectively. CT scan analysis showed annular coronal diameter 26±2mm, sagittal diameter 22±3mm, mid-sinusal diameter 36±4mm, sinus-tubular junction 27±5mm, annular eccentricity index 0.9±0.1. Mean number of calcified commisures 1.9± 1.1, mean number of annular calcium spots 2.3±1.2. Edwards valve was used in 13 (19.1%), while CoreValve in 55 (80.8%). Mean valve size was 27.1±2.2 mm. Mean balloon size was 25.6±2.3mm. Postdilatation was effective in reducing AR by 1 grade in 42 patients (79%). Effective post dilatation was achieved in 100% of patients with a “post dilatation balloon diameter/ coronal diameter ratio” 0.85-1.07. Outcome of post dilatation was not influenced by the annular eccentricity index. AR following postdilatation was more in patients with heavily calcified annulus. 1 patient (1.5%) had annular tear following post dilatation. 30 days echocardiographic follow up showed 1.1±0.9 AR.

Effectiveness of post dilatation is multifactorial and depends mainly on the proper choice of the balloon size, which in terms depends on the annular coronal diameter assessed by CT scan. Since commisural calcification and annular eccentricity index don't influence the outcome of post dilatation, there is no need for aggressive postdilatation to reduce AR after valve implantation.