Hemodynamic Improvement With the Double-Tap Technique During Transcatheter Aortic Valve Replacement Using a Pressure-Sensing Guidewire

Postdilatation using the original delivery system balloon at the same filling volume (the double-tap technique) has been proposed to improve balloon-expandable transcatheter heart valve (THV) expansion during transcatheter aortic valve replacement (TAVR); however, its immediate hemodynamic impact remains unclear. Here, we report a case series of 6 consecutive patients who underwent TAVR with balloon-expandable valves in whom the double-tap technique was performed with hemodynamic assessment using a pressure-sensing guidewire. The mean transvalvular pressure gradients and midportion THV diameters were evaluated before and after the double-tap technique. This technique was significantly associated with reduced mean transvalvular pressure gradients (median difference: -6.5 mm Hg; P = 0.036) and increased midportion THV diameter (median difference: 0.8 mm; P = 0.036), whereas paravalvular leak was reduced to trivial or none in all patients, and no cardiovascular death, stroke, or permanent pacemaker implantation occurred at 30 days. The double-tap technique under pressure-sensing guidewire guidance may facilitate safer valve optimization during TAVR.