# DUOTAP Trial: Routine Postdilation Improves TAVR Valve Geometry Routine balloon reinflation during TAVR reduces valve asymmetry and improves hemodynamic outcomes. - **Source:** [MedPage Today](https://www.medpagetoday.com) - **Published:** 2026-11-05 - **Topic:** [health](https://brifing.si/c/health) - **Original article:** - **On Brifing:** https://brifing.si/s/8e4d8c83-e749-4c93-a40c-3ee37e888a86 ## The DUOTAP Trial Findings The DUOTAP trial investigated the impact of routine postdilation during transcatheter aortic valve replacement (TAVR) procedures. Conducted at the Medical University of Vienna, the study randomized 148 patients to assess whether a secondary balloon inflation could optimize valve geometry. Results showed a 70% reduction in transcatheter heart valve asymmetry compared to standard procedures. ## Hemodynamic and Structural Benefits Routine postdilation demonstrated significant downstream clinical benefits for patients undergoing TAVR. Researchers observed a 67% reduction in more-than-mild paravalvular leak on pre-discharge echocardiography. Additionally, cardiac CT scans at three months revealed a 63% reduction in hypo-attenuated leaflet thickening, suggesting improved valve performance and structural integrity following the secondary balloon inflation procedure. ## Addressing Valve Asymmetry Concerns Asymmetric device expansion in TAVR is often associated with higher residual gradients and impaired valve performance. By performing a double tap, operators can correct the geometry of the Sapien balloon-expandable platform. This intervention effectively reduces valve height on the device's outer curve, ensuring a more symmetrical fit within the patient's aortic annulus. ## Safety and Procedural Risks Safety remains a primary concern when considering routine postdilation due to risks like annulus rupture or valve migration. However, the DUOTAP trial reported a favorable safety trend, with 24.3% of postdilation patients experiencing adverse events compared to 31.1% in the control group. Pacemaker implantation rates remained comparable between both study arms at 30 days. ## Expert Perspectives on Implementation Medical experts at the Transcatheter Cardiovascular Therapeutics conference debated the universal application of postdilation. While some clinicians advocate for selective use based on imaging, others suggest the data provides strong motivation for routine adoption. Panelists emphasized that the ultimate goal remains achieving maximum valve expansion tailored to the specific needs of each patient. ## Future Clinical Implications While the immediate hemodynamic improvements are clear, researchers caution that long-term clinical outcomes remain unknown. It is currently unclear if these structural gains translate into increased valve durability over several years. Future studies are required to determine if the reduction in leaflet thickening and paravalvular leaks leads to improved patient survival rates. ## Study Methodology and Cohort The single-blind, single-center trial enrolled patients with severe aortic stenosis who were candidates for transfemoral TAVR. The cohort had a median age of 81 years, with 47% women and a EuroScore-II of 2.3%. Participants with bicuspid aortic valves or high-risk CT features were excluded to ensure a standardized analysis of the intervention. ## Technological Integration in TAVR Clinicians are increasingly looking toward advanced imaging and artificial intelligence to guide procedural decisions. Current practices often lack precise assessment of how a valve expands upon deployment. Integrating echo, fluoroscopy, and AI could help operators identify which patients specifically require postdilation, moving the field toward more personalized and optimized cardiac interventions. ## Sources covering this story - https://www.medpagetoday.com/meetingcoverage/tct/123743 — --- _Summary written by Brifing from the original reporting. Copyright in the original article belongs to its publisher; read the full piece at the link above._