Late Balloon Valvuloplasty for Transcatheter Heart Valve Dys
All patients who underwent late dilatation for symptomatic transcatheter heart valve (THV) dysfunction at two institutions between 2016–2021 were identified. Baseline, procedural characteristics, and clinical and echocardiographic outcomes were documented. THV frame expansion was assessed by multislice computed tomography before and after late dilatation.

Late dilatation was performed in 30 patients a median of 4.6 months (interquartile range [IQR], 2.3-11.0 months) after THV implantation in the aortic (n = 25; 83.3%), mitral (n = 2; 6.7%), tricuspid (n = 2; 6.7%), and pulmonary (n = 1; 3.3%) position. THV underexpansion was documented at baseline, and frame expansion substantially improved after late dilatation. The mean transvalvular gradient fell in all patients. For aortic THVs specifically, mean transaortic gradient fell from 25.4 ± 13.9 mm Hg to 10.8 ± 4.1 mm Hg; p < 0.001. Paravalvular leak (PVL) was reduced to mild in all 11 patients with a previous > mild PVL. Embolic events, stroke, annular injury, and bioprosthetic leaflet injury were not observed. Symptomatic benefit was durable at 19.6 months’ (IQR, 14.8-36.1 months) follow-up.

Balloon dilatation late after THV implantation appears feasible and safe in appropriately selected patients and may result in THV frame expansion resulting in improvements in hemodynamic performance and PVL.