Balloon aortic valvuloplasty in high risk aortic stenosis patients with left ventricular ejection fractions <20%

Abstract

Objectives: To determine outcomes following balloon aortic valvuloplasty (BAV) in aortic stenosis (AS) patients with a left ventricular ejection fraction (LVEF) <20%. Background: Severe AS patients with a LVEF <20% are excluded from United States (U.S.) transcatheter aortic valve replacement (TAVR) trials and often surgical aortic valve replacement (AVR). The role for BAV to enhance LVEF is unclear. Methods: Our BAV database of 270 consecutive patients extending from 2005 through 2010 was queried for a preoperative LVEF <20%. Demographics, echocardiograms, procedural technique, and outcomes were analyzed. Pre-and postoperative echocardiograms were used to determine improvement in aortic valve area (AVA) and LVEF. Results: Sixteen patients were identified with a median age of 82 years. The composite Society of Thoracic Surgeons' (STS) mortality risk was 16.4%. The median preoperative AVA and LVEF were 0.60 cm 2 and 16%, respectively, and postoperative AVA and LVEF were 0.77 cm 2 and LVEF 19%, respectively. About 15 of the 16 patients had postoperative echocardiograms available for comparison. And 7 of these 15 (47%) demonstrated improvement in LVEF to !20% (median LVEF 25%). The absence of coronary disease and improvement in AVA of !0.2 cm 2 was associated with postoperative LVEF of !20%. Procedural mortality was 0%. The 30-day, 6-month, and 1-year survival was 69%, 56%, and 29%. STS's mortality risk score !15% was associated with short-term mortality. Conclusion: With appropriate technique, BAV can be reasonably safe in patients with LVEF <20%. Roughly half of these patients demonstrated improvement in LVEF to !20%. V C 2013 Wiley Periodicals, Inc.

Long-term results of percutaneous balloon valvuloplasty of congenital aortic stenosis in adolescents and young adults

“…Also, in consistent with the observed studies, the ventricular dysfunction improved significantly in all the age groups after BAV 15 . Pedersen et al have demonstrated the same even in the elderly population 16, 17. All the patients in the present study underwent BAV using low-profile Tyshak II balloon, which have shown good results in various studies 18 .…”

“…Our restenosis rate was comparable and aortic insufficiency rate and surgical rate were lower than many other reported studies 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20. O Reich et al 4 followed up over a period of 15 years showed restenosis rate of 16.7% ( n = 45) and significant insufficiency in 22.3% ( n = 60); surgery was needed in 20.1% ( n = 54), and “valvuloplasty failure” occurred in 41.6% ( n = 112) of patients.…”

Balloon aortic valvuloplasty in contemporary practice

“…Most studies report a small change in valve area following BAV, and this was true in our series. Although the change was statistically significant, the difference was not enough to explain the marked improvement in symptoms we observed.…”

Transcatheter aortic valve replacement and standard therapy in inoperable patients with aortic stenosis and low EF

“…We found that nearly half of patients with baseline LV dysfunction experienced early improvement in LVEF after TAVR, while less than one-third of patients do so with standard therapy. This improvement in LV systolic function during standard therapy is largely attributable to optimisation of medical management as well as to balloon aortic valvuloplasty (BAV) 19 20. Patients with LV systolic dysfunction and severe AS are exquisitely sensitive to afterload,21 and previous studies have shown that the modest reductions in LV pressure load seen with BAV can lead to improved LV function 22 23…”