Contemporary balloon aortic valvuloplasty: Changing indications and refined technique

Abstract

Even if un to improve long‐term prognosis, balloon aortic valvuloplasty (BAV) may be useful in selected patients with symptomatic severe aortic stenosis either as a bridge to surgical or transcatheter valve replacement (aortic valve replacement [AVR] or transcatheter aortic valve implantation [TAVI]) or as a triage strategy for patients with uncertain indications. International guidelines recommend BAV as: a “bridge” to AVR/TAVI, a “trial” in patients with undetermined symptoms, or a “bridge‐to‐decision” in case of comorbidities. However, in clinical practice, BAV is also used as a palliative measure to improve hemodynamics and quality of life in many patients who are excluded from AVR/TAVI. Finally, BAV is often performed during TAVI to facilitate prosthesis delivery, optimize frame expansion, or for bioprosthetic valve fracture in selected valve‐in‐valve procedures. Technical innovations, which allow for a mini‐invasive approach via transradial access and pacing delivered through the wire, have led to a decrease in complications over time. This review focuses on contemporary BAV with a specific emphasis on new indications, innovative techniques, and specific complex patient subgroups.

Balloon Aortic Valvuloplasty in the Transcatheter Aortic Valve Implantation Era

“…In terms of complications, acute aortic regurgitation and haematocrit drop independently predict death. 15,17,47,51 Complications can be classified as those associated with the valve intervention and those related to the vascular access. Complications associated with the valve intervention are infrequent and represent less than 3% of of the total complications reported, but are usually catastrophic.…”

“…BAV indications can be classified by considering the intervention as a bridge to AVR/TAVI or as destination therapy, whereby no further procedures are undertaken, other than repeated BAV. 17 Nevertheless, there is a broad range of indications whereby BAV cannot be considered either as definitive or as a bridge to TAVI/AVR. These include diagnosing the impact of AS in a clinical situation, improving frailty, reducing the risk of non-cardiac interventions by releasing the aortic gradient and reducing the risk of waiting for definitive treatment.…”

Aortenklappe: wann konservativ, wann operativ, wann interventionell?

“…Bei sehr alten Patienten kann eine palliative BAV zu Symptomlinderung und Verbesserung der Lebensqualität führen [19].…”

Snuffbox approach for balloon aortic valvuloplasty: A case series

“…As the population ages, the prevalence of aortic stenosis has increased. Transcatheter aortic valve replacement (TAVR) had extended the spectrum of indications for balloon aortic valvuloplasty (BAV) as a bridge to TAVR in old patients symptomatic for aortic stenosis 1 . However, the persistent presence of BAV‐related adverse vascular events (9–10% in published data with transfemoral access) encouraged a minimally invasive approach to BAV using the radial artery.…”