Incomplete expansion of balloon-expandable (BE) transcatheter heart valves (THVs) remains a common challenge after transcatheter aortic valve implantation (TAVI). Conventional post-dilatation using overfilled or larger balloons can enhance expansion but increases the risk of adverse events. In this context, the “double-tap” approach uses the original delivery balloon at its nominal filling volume to improve valve expansion with potentially lower risk.

A prospective study published in EuroIntervention evaluated this method in 102 patients undergoing TAVI with a balloon-expandable THV. Patients with severe annular or subannular calcification were excluded. Fluoroscopic analysis measured cross-sectional areas at the inflow, midpoint, and outflow before and after double-tap. Across valve sizes, minimal THV expansion improved by 8.6 to 9.9%, with significant gains for most. No strokes or cardiovascular deaths occurred within 30 days, confirming procedural safety.

These findings suggest that, in favorable anatomy, routine double-tap post-dilatation safely enhances valve expansion. Further studies are warranted to determine its impact on valve function, hemodynamic performance, and long-term durability.