Citation: American Journal of Cardiology. 121(11):1358-1364, 2018 06 01..Journal: The American journal of cardiology.Published: 2018ISSN: 0002-9149.Full author list: Rogers T; Waksman R; Harrison JK; Deeb GM; Zhang AQ; Hermiller JB Jr; Popma JJ; Reardon MJ.UI/PMID: 29680171.Subject(s): Acute Kidney Injury/ep [Epidemiology] | Aged | Aged, 80 and over | *Aortic Valve Stenosis/su [Surgery] | Bundle-Branch Block/ep [Epidemiology] | Bundle-Branch Block/th [Therapy] | Cardiac Pacing, Artificial | *Dilatation/mt [Methods] | Echocardiography | Female | *Heart Valve Prosthesis | Hemodynamics | Humans | Male | Mortality | Myocardial Infarction/ep [Epidemiology] | Pacemaker, Artificial | Severity of Illness Index | Stroke/ep [Epidemiology] | *Transcatheter Aortic Valve Replacement/mt [Methods] | Treatment OutcomeInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access onlineDigital Object Identifier: https://dx.doi.org/10.1016/j.amjcard.2018.02.008 (Click here)Abbreviated citation: Am J Cardiol. 121(11):1358-1364, 2018 06 01.Local Holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006.Abstract: The impact of predilatation (Pre-Dil) on prosthesis hemodynamics and clinical outcomes of subjects who underwent transcatheter aortic valve implantation (TAVI) with a self-expanding prosthesis remains unclear. Two thousand seven hundred twenty-one subjects from the extreme- and high-risk CoreValve Continued Access Study (CAS) were included in the analysis. Subjects who underwent Pre-Dil before TAVI were compared with subjects who underwent TAVI without Pre-Dil. Clinical outcomes included death, stroke, myocardial infarction, acute kidney injury, and new permanent pacemaker implantation. Serial echocardiograms were analyzed to evaluate prosthesis hemodynamics, specifically paravalvular regurgitation, effective orifice area, and mean gradient. Two thousand one hundred eighteen and 603 subjects underwent TAVI with and without Pre-Dil, respectively. Subjects in the Pre-Dil cohort were more commonly male, while subjects in the no Pre-Dil cohort had higher rates of previous stroke and lower mean aortic valve gradients. Outcomes at 30 days were comparable between Pre-Dil and no Pre-Dil subjects, with no significant difference in mortality (5.5% vs 4.3%, p=0.27), major stroke (2.6% vs 2.2%, p=0.54), major vascular complications (6.9% vs 8.0%, p=0.37), major bleeding (24.4% vs 26.1%, p=0.40), and permanent pacemaker implantation (21.3% vs 23.4%, p=0.36). There were no significant differences in the same outcomes at 12 months. Effective orifice area and mean gradient were comparable between Pre-Dil and no-Pre-Dil subjects at discharge, at 30 days, and at 12 months. In conclusion, when performing TAVI with the self-expanding CoreValve device, performing direct implantation without Pre-Dil maintains an acceptable safety profile and still achieves desired and consistent prosthesis hemodynamics.Abstract: Copyright (c) 2018 Elsevier Inc. All rights reserved.