Pre- and post-dilatation in transcatheter aortic valve implantation with self-expanding valves: a systematic review and meta-analysis
In brief
Post-dilatation after self-expanding TAVI linked to about 40% higher 30-day mortality
In pooled observational data, patients who required post-dilatation of self-expanding transcatheter aortic valves had roughly 40% higher odds of dying within 30 days, more than three-fold higher risk of moderate or greater leak, and more frequent surgical conversion, while stroke and pacemaker rates were unchanged.
- Journal
- Frontiers in cardiovascular medicine (Q1)
- Published
- 26 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Bing Wei Thaddeus Soh, Ailís Pollock, Dominic Butler, Angela McInerney, John William McEvoy, Darren Mylotte
- PMID
- 42719126
- DOI
- 10.3389/fcvm.2026.1883882
Why clinicians should know about it
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Abstract
INTRODUCTION: Pre-dilatation balloon aortic valvuloplasty (PRE-BAV) and post-dilatation (POST-DIL) are commonly used during transcatheter aortic valve implantation with self-expanding valves (SEV-TAVI) to facilitate device delivery and optimize valve expansion, but both may increase procedural complications. METHODS: We conducted a systematic review and meta-analysis to evaluate outcomes associated with PRE-BAV and POST-DIL compared with direct implantation (DIRECT) and valves left as deployed (AS-DEPLOYED), respectively. Eleven studies (nine observational, two randomised; 24,143 patients) were included for PRE-BAV and five observational studies (7,526 patients) for POST-DIL. Key outcomes included mortality, stroke, permanent pacemaker implantation, and moderate or greater paravalvular leak (PVL2+). Random-effects meta-analyses with Hartung-Knapp-Sidik-Jonkman adjustment were used to estimate pooled odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: Compared with DIRECT, PRE-BAV was not associated with differences in mortality, stroke, pacemaker implantation, or PVL2+, but randomised data showed a reduced need for POST-DIL (OR 0.43; 95% CI 0.24-0.74). Compared with AS-DEPLOYED, observational series suggested that POST-DIL was linked to higher 30-day mortality (OR 1.39; 95% CI 1.18-1.63), increased PVL2+ (OR 3.76; 95% CI 2.13-6.63), and more frequent surgical conversion (OR 1.22; 95% CI 1.06-1.41), with no differences in stroke or pacemaker implantation. DISCUSSION: PRE-BAV was not associated with increased adverse outcomes and may reduce the need for post-dilatation, whereas the adverse outcomes observed with POST-DIL in observational studies are most likely explained by confounding by indication rather than a causal effect. Further adequately powered randomised trials are needed to define the optimal balloon dilatation strategy in SEV-TAVI. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024610604.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.