Direct Rapid Left Ventricular Wire Pacing during Balloon Aortic Valvuloplasty

Kleczyński, Paweł; Dziewierz, Artur; Socha, Sylwia; Rakowski, Tomasz; Daniec, Marzena; Zawiślak, Barbara; Arif, Saleh; Wojtasik-Bakalarz, Joanna; Dudek, Dariusz; Rzeszutko, Łukasz

doi:10.3390/jcm9041017

Cited by 14 publications

(14 citation statements)

References 18 publications

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“…Our observations are in line with data shown in other studies showing reprise of BAV in the era of TAVI [3,4,8,9,[11][12][13]15,16,20,22]. When BAV is used as a bridge, it gives some time and opportunity to improve the clinical and hemodynamic response among treated patients with severe AS not being appropriate candidates for final treatment at that time point.…”

Section: Discussionsupporting

confidence: 91%

“…Procedure-related complications rate was similar to that showed in previous studies [3,8,9,13,15,16]. A high rate of vascular complications, up to 12.5%, was reported and mostly related to the use of large arterial sheaths (8-10 F) and peripheral arterial disease.…”

Section: Discussionsupporting

confidence: 87%

“…Balloon sizes were chosen depending on a minimal annulus diameter measured in TTE or based on CT scans, if available. The exact positioning of the balloon during inflation was obtained with rapid ventricular pacing from either the 0.035" ultra-stiff guidewire inserted into the left ventricle (LV) or the temporary pacemaker inserted into the right ventricle (RV) (via a 6 or 7 Fr venous sheath) [9,10]. The number of balloon inflations was left to the operator's discretion.…”

Section: Methodsmentioning

confidence: 99%

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Balloon Aortic Valvuloplasty for Severe Aortic Stenosis as Rescue or Bridge Therapy

Kleczyński

Kulbat

Brzychczy

et al. 2021

JCM

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The study aimed to assess procedural complications, patient flow and clinical outcomes after balloon aortic valvuloplasty (BAV) as rescue or bridge therapy, based on data from our registry. A total of 382 BAVs in 374 patients was performed. The main primary indication for BAV was a bridge for TAVI (n = 185, 49.4%). Other indications included a bridge for AVR (n = 26, 6.9%) and rescue procedure in hemodynamically unstable patients (n = 139, 37.2%). The mortality rate at 30 days, 6 and 12 months was 10.4%, 21.6%, 28.3%, respectively. In rescue patients, the death rate raised to 66.9% at 12 months. A significant improvement in symptoms was confirmed after BAV, after 30 days, 6 months, and in survivors after 1 year (p < 0.05 for all). Independent predictors of 12-month mortality were baseline STS score [HR (95% CI) 1.42 (1.34 to 2.88), p < 0.0001], baseline LVEF <20% [HR (95% CI) 1.89 (1.55–2.83), p < 0.0001] and LVEF <30% at 1 month [HR (95% CI) 1.97 (1.62–3.67), p < 0.0001] adjusted for age/gender. In everyday clinical practice in the TAVI era, there are still clinical indications to BAV a standalone procedure as a bridge to surgery, TAVI or for urgent high risk non-cardiac surgical procedures. Patients may improve clinically after BAV with LV function recovery, allowing to perform final therapy, within limited time window, for severe AS which ameliorates long-term outcomes. On the other hand, in patients for whom an isolated BAV becomes a destination therapy, prognosis is extremely poor.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 87%

Section: Methodsmentioning

confidence: 99%

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Balloon Aortic Valvuloplasty for Severe Aortic Stenosis as Rescue or Bridge Therapy

Kleczyński

Kulbat

Brzychczy

et al. 2021

JCM

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“…However, rapid ventricular pacing may be mandatory for optimal balloon positioning during BAV in children, adolescents, and adults. Rapid ventricular pacing can be achieved through (1) direct LV guidewire pacing or (2) regular pacing mediated by a temporary pacemaker (PM) placed in the right ventricle [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Balloon Valvuloplasty for Congenital Aortic Stenosis: Experience at a Tertiary Center in a Developing Country

Charafeddine

Houssein

Kibbi

et al. 2021

Journal of Interventional Cardiology

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Background. Aortic valve stenosis accounts for 3–6% of congenital heart disease. Balloon aortic valvuloplasty (BAV) is the preferred therapeutic intervention in many centers. However, most of the reported data are from developed countries. Materials and Methods. We performed a retrospective single-center study involving consecutive eligible neonates and infants with congenital aortic stenosis admitted for percutaneous BAV between January 2005 and January 2016 to our tertiary center. We evaluated the short- and mid-term outcomes associated with the use of BAV as a treatment for congenital aortic stenosis (CAS) at a tertiary center in a developing country. Similarly, we compared these outcomes to those reported in developed countries. Results. During the study period, a total of thirty patients, newborns (n = 15) and infants/children (n = 15), underwent BAV. Left ventricular systolic dysfunction was present in 56% of the patients. Isolated AS was present in 19 patients (63%). Associated anomalies were present in 11 patients (37%): seven (21%) had coarctation of the aorta, two (6%) had restrictive ventricular septal defects, one had mild Ebstein anomaly, one had Shone’s syndrome, and one had cleft mitral valve. BAV was not associated with perioperative or immediate postoperative mortality. Immediately following the valvuloplasty, a more than mild aortic regurgitation was noted only in two patients (7%). A none-to-mild aortic regurgitation was noted in the remaining 93%. One patient died three months after the procedure. At a mean follow-up of 7 years, twenty patients (69%) had more than mild aortic regurgitation, and four patients (13%) required surgical intervention. Kaplan–Meier freedom from aortic valve reintervention was 97% at 1 year and 87% at 10 years of follow-up. Conclusion. Based on outcomes encountered at a tertiary center in a developing country, BAV is an effective and safe modality associated with low complication rates comparable to those reported in developed countries.

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“…Detailed material and methods were described previously [ 10 , 11 ]. Transthoracic echocardiography (TTE) served as a tool for MR assessment at baseline, after 30 days and at 6 months.…”

Section: Methodsmentioning

confidence: 99%

Balloon aortic valvuloplasty for severe aortic stenosis may reduce mitral regurgitation in mid-term follow-up

Kleczyński¹,

Brzychczy²,

Kulbat³

et al. 2022

pwki

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Introduction: Mitral regurgitation (MR) is a frequent complication in patients with severe aortic stenosis (AS). Material and methods: Echocardiographic assessment of MR was performed at baseline, at 30 days and at 6 months after balloon aortic valvuloplasty (BAV).Results: Data of 271 patients were included in our final analysis, of which 21.2% (n = 85) had at least moderate MR at baseline (in 19 (22.3%) subjects MR was diagnosed as primary). Both groups showed similar severity of AS, but patients in the MR group had a greater left ventricle (LV) size (p = 0.003 for LVESD, p = 0002 for LVEDD) and slightly lower LV ejection fraction (p = 0.04). Mitral regurgitation parameters significantly improved both at 30 days and 6 months after BAV in the MR group (MR jet area: 7.2 (4.5-9.9) vs. 3.6 (2.3-7.2) cm 2 , and 7.2 (4.5-9.9) vs. 3.2 (2.1-6.7) cm 2 ; %MR/left atrial area 34.5 (23.4-42.7) vs. 17.5 (9.3-29.5) and 34.5 (23.4-42.7) vs. 14.5 (8.3-24.5), p < 0.001 for all). In multivariate logistic regression analysis, the change at 30 days, from baseline, in the LVESD (OR = 1.87; 95% CI: 1.23-2.87; p < 0.001) and LVEF (OR = 0.95; 95% CI: 0.87-1.01; p < 0.001); MR jet area (OR = 2.2, 95% CI: 1.5-4.6; p < 0.001) and the presence of primary MR (OR = 3.2, 95% CI: 1.04-5.98; p < 0.001) were retained as independent predictors of significant persisting MR at 6 months.Conclusions: Balloon aortic valvuloplasty may reduce MR in mid-term follow-up. Predictors of persistent MR at 6 months after BAV included an increase of LVESD and MR jet area and decrease of LVEF at 30 days.

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Direct Rapid Left Ventricular Wire Pacing during Balloon Aortic Valvuloplasty

Cited by 14 publications

References 18 publications

Balloon Aortic Valvuloplasty for Severe Aortic Stenosis as Rescue or Bridge Therapy

Balloon Aortic Valvuloplasty for Severe Aortic Stenosis as Rescue or Bridge Therapy

Balloon Valvuloplasty for Congenital Aortic Stenosis: Experience at a Tertiary Center in a Developing Country

Balloon aortic valvuloplasty for severe aortic stenosis may reduce mitral regurgitation in mid-term follow-up

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