Balloon aortic valvuloplasty — ups and downs — are we facing a procedure comeback?

Abstract

A b s t r a c t Background:Recently, there has been renewed interest in balloon aortic valvuloplasty (BAV). Aim:To analyse the indications and short-term outcome of BAV since transcatheter aortic valve implantation (TAVI) was launched in our institution. Methods:Between September 2010 and September 2014, 25 consecutive patients (19 female, 6 male) underwent BAV. The mean age was 72 ± 11.4 years, mean EuroScore II was 10.4 ± 11.7%, mean logistic EuroScore 23.5 ± 23.6%, mean Society of Thoracic Surgeons mortality risk score was 21.8 ± 13.6%. The indications for BAV were: advanced haemodynamically unstable heart failure (HF) including cardiogenic shock or pulmonary oedema (n = 7), co-morbidities requiring urgent non-cardiac surgery (n = 8), palliative treatment (n = 6), and an intension to bridge to TAVI or aortic valve replacement in patients with severe HF (n = 4). Results:In-hospital mortality was 20% (n = 5) and occurred in patients who underwent BAV in the setting of haemodynamically unstable HF. Other major complications included pacemaker implantation (n = 2), major vascular complications (n = 4), and cardiac tamponade (n = 1). There were no patients who required conversion to cardiac surgery. The mean peak aortic transvalvular gradient decreased from 96.9 ± 29.5 to 60.3 ± 15.5 mm Hg (p = 0.0001) after BAV. We did not observe significant aortic regurgitation. Conclusions:Treatment of advanced and haemodynamically unstable aortic stenosis, bridge to non-cardiac surgery and palliative therapy are the main reasons for BAV in recent years. BAV as a bridge to TAVI or aortic valve replacement may be an option for some patients. Short-term results are good with relatively low mortality and morbidity related to the procedure. Mortality in haemodynamically unstable patients presenting with cardiogenic shock or pulmonary oedema treated with BAV is very high.

Acute and long‐term outcomes of percutaneous balloon aortic valvuloplasty for the treatment of severe aortic stenosis

“…Death were classified as cardiovascular in 14 (73.7%) cases (recurrent heart failure, sudden death, major stroke, pulmonary embolism) and noncardiovascular in 5 (26.3%) cases (cancer, major gastrointestinal bleeding). Patients who were treated with BAV due to cardiogenic shock had the worst prognosis with 100% mortality in this group . Mortality rate was also high among palliative patients n = 9 (41%).…”

In-Hospital Mortality after Balloon Aortic Valvuloplasty

“…On further review of the in-hospital mortality group occurring within the first decade at this institution, all were associated with vascular complications resulting in excessive bleeding. Similarly, other studies have reported this complication along with other serious outcomes including stroke, acute aortic regurgitation, and myocardial infarction in 10-20% or more of patients [18,[19][20][21][22]. With improvements in vascular closure devices, patient outcomes have improved.…”

Balloon Aortic Valvuloplasty in Patients Admitted for Cardiogenic Shock with Severe Aortic Stenosis: A Retrospective Analysis of 14 Cases

“…Except for Debry and colleagues’ work, which is the latest study, all previous papers present no more than two dozen patients in single-center studies, while using different definitions for cardiogenic shock and employing logistic Euroscore for patient characterization, instead of the more recent Euroscore II. Olasinska-Wisniewska and colleagues also report cases of patients in cardiogenic shock using the latest Euroscore II, although they make no distinction between patients with cardiogenic shock and pulmonary edema due to severe heart failure [23]. Some report the peak aortic gradient change while others report the mean aortic gradient change after BAV.…”