Postdilation of Evolut Transcatheter Heart Valves: Insights From Bench Testing

In this brief report, the authors present an ex vivo bench study evaluating the impact of post-dilation strategies on Evolut FX+ transcatheter heart valves (23, 26, 29, and 34 mm). Valves were expanded in an elliptical annular model and underwent post-dilation using balloons either within or exceeding the instructions for use recommendations. Instructions for use-guided post-dilation preserved frame geometry, caused no leaflet damage, and maintained the regurgitant fraction below thresholds (<20 percent), remaining below 5 percent after 200 million accelerated wear cycles, simulating five years. In contrast, off-guidance balloon oversizing or inflation greater than two atmospheres caused waist overexpansion and leaflet tears at the skirt attachment site, with increased regurgitation. The authors conclude that excessive post-dilation may compromise leaflet integrity and durability.