Research Article Aortic Valve Predilatation with a Small Balloon, without Rapid Pacing, prior to Transfemoral Transcatheter Aortic Valve Replacement Anupama Shivaraju, 1,2 Christian Thilo, 3 Neal Sawlani, 2 Ilka Ott, 1 Heribert Schunkert, 1,4 Wolfgang von Scheidt, 3 Adnan Kastrati, 1,4 and Albert Markus Kasel 1,3 1 Deutsches Herzzentrum M¨ unchen, Department for Cardiovascular Diseases, Technische Universit¨ at M¨ unchen, Lazarettstr. 36, 80636 Munich, Germany 2 Department of Cardiology, Advocate Christ Medical Center, 4440 W. 95th Street, Oak Lawn, IL, USA 3 Department of Cardiology, Klinikum Augsburg, Herzzentrum Augsburg-Schwaben, Stenglinstr. 2, 86156 Augsburg, Germany 4 Deutsches Zentrum f¨ ur Herz- und Kreislauforschung (DZHK), Munich Heart Alliance, Munich, Germany Correspondence should be addressed to Albert Markus Kasel; markus kasel@web.de Received 16 July 2017; Revised 28 February 2018; Accepted 14 March 2018; Published 30 April 2018 Academic Editor: Giovanni Mariscalco Copyright © 2018 Anupama Shivaraju et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives. Te aim of this study is to assess the feasibility and clinical outcome of transcatheter aortic valve replacement (TAVR) using aortic valve predilatation (AVPD) with a small, nonocclusive balloon. Background. Balloon aortic valvuloplasty (BAV) under rapid pacing is generally performed in TAVR to ensure the passage and sufcient deployment of the prosthesis in the stenotic AV. BAV may cause serious complications, such as lef ventricular stunning or cerebrovascular embolism. Methods. A cohort of 50 consecutive patients with severe aortic stenosis underwent transfemoral TAVR with the Edwards Sapien 3-heart valve. All patients underwent AVPD with a small, nonocclusive balloon (12 × 60 or 14 × 60 mm) without rapid pacing. Procedural data and clinical outcomes were analyzed. Results. Te mean age of the cohort was 81±6 years and the mean logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) was 13 ± 9. Crossing the AV and prosthesis implantation was successful in all cases. Te postprocedural mean AV gradient was 12 ± 5 mmHg. Tere were no cases of aortic regurgitation ≥ grade 2. No periprocedural stroke occurred. One patient (2%) with chronic atrial fbrillation displayed a transient Wernicke aphasia occurring more than 24 hours afer TAVR. Mortality was 0% at 30 days afer procedure. Conclusion. In TAVR, AVPD with a small, nonocclusive balloon can be safely performed. By avoiding rapid pacing, this technique may be a valid alternative to traditional BAV. Whether or not the use of APVD without rapid pacing translates into less periprocedural complications needs to be assessed in future studies. 1. Introduction Transfemoral transcatheter aortic valve replacement (TAVR) has evolved into the standard of care for patients with severe, symptomatic aortic stenosis (AS) at intermediate, inoperable, or high surgical risk [1]. As device caliber and technological improvements continue to garner increasing attention, some cornerstones of transfemoral implantation techniques remain unchanged. Such principles are rapid pacing and balloon aortic valvuloplasty (BAV) prior to valve implantation [2, 3]. However, the impact of transient ventricular stunning during rapid pacing is unclear, and BAV during TAVR may contribute to cerebral microembolization of calcifed debris from the aortic valve [4, 5]. Te aim of our current study is to assess the safety and feasibility of AVPD prior to TAVR using a small and nonocclusive balloon without the use of rapid ventricular pacing. 2. Methods 2.1. Patient Selection and Preparation. From February 2014 until June 2014, we prospectively evaluated and treated 50 Hindawi BioMed Research International Volume 2018, Article ID 1080597, 6 pages https://doi.org/10.1155/2018/1080597