To do or not to do? Changing paradigms: value of balloon-sizing and left atrial appendage occlusion

Summary Balloon-sizing of the aortic annulus can be considered the “gold-standard” for annulus-assessment for transcatheter aortic valve implantation (TAVI) – comparable to intraoperative surgical sizing tools. We report a case of an 83 year-old patient referred for TAVI, where CT-angiogram measurements might have prevented us from performing TAVI and balloon-sizing allowed us to proceed with an excellent final result. Since patients with concomitant atrial fibrillation undergoing TAVI are known to have worse short- and long-term outcomes, left atrial appendage occlusion (LAAO) at the same sitting was successfully performed, to obviate the need for oral anticoagulation. Combining procedures (e.g. TAVI and LAAO) is technically feasible, patient-friendly and should be encouraged where reasonable, despite contrary financial incentives by our health care system.