Emerging indications, in-hospital and long-term outcome of balloon aortic valvuloplasty in the transcatheter aortic valve implantation era

Saia, Francesco; Marrozzini, Cinzia; Ciuca, Cristina; Guastaroba, Paolo; Taglieri, Nevio; Palmerini, Tullio; Bordoni, Barbara; Moretti, Carolina; Dall’Ara, Gianni; Branzi, Angelo; Marzocchi, Antonío

doi:10.4244/eijv8i12a212

Cited by 85 publications

(87 citation statements)

References 21 publications

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“…Our study confirms the observations of other authors [6,7], that currently BAV has favourable acute outcome with a low rate of major complications, and is an acceptable bridge to subsequent intervention in the very high-risk population not immediately suitable for definite therapy.…”

Section: Discussionsupporting

confidence: 81%

“…A similar observation of worse prognosis of BAV in course of cardiogenic shock was established in the large analysis performed by Saia at al. [6]. They presented in-hospital mortality of 56.5% in patients who underwent BAV in the setting of cardiogenic shock compared with 2% in the stable subgroups of patients treated with BAV.…”

Section: Discussionmentioning

confidence: 99%

“…We did not observe significant aortic regurgitation in any of our patients. According to Saia et al [6], low incidence of stroke suggests that major embolisation with debris from the aortic valve is a rare phenomenon with experienced operators, although silent micro-embolisation cannot be ruled out.…”

Section: Discussionmentioning

confidence: 99%

“…Saia et al [6] concluded that the number of BAV is increasing, mainly due to increased referral of high-risk patients and to the emerging indication of bridge for TAVI.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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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.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Saia et al [6] concluded that the number of BAV is increasing, mainly due to increased referral of high-risk patients and to the emerging indication of bridge for TAVI.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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“…16 Several studies have correlated the presence of renal insufficiency before the procedure with increased mortality. 9,17,18 A study of 262 patients at high surgical risk undergoing BAV showed that creatinine clearance ≤ 60 mL/min before the procedure is a strong predictor of mortality. 7 The absence of vascular complications in this study may be related to the use of sheaths with small calibre (10F) in all patients, as well as to the immediate withdrawal of the sheath.…”

Section: Discussionmentioning

confidence: 99%

Valvuloplastia aórtica por cateter balão na estenose aórtica degenerativa: impacto terapêutico em pacientes em condição clínica in extremis

Vahle¹,

Pintón²,

Melo³

et al. 2013

Rev. Bras. Cardiol. Invasiva

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Background: Balloon aortic valvuloplasty (BAV) is used as a palliative strategy in patients who are not eligible for valve replacement surgery, transcatheter aortic valve implantation, or as a bridge to these treatment modalities. The impact of BAV as a salvage procedure for patients in extreme clinical conditions (in extremis) is unknown. Methods: Patients with severe degenerative aortic stenosis undergoing BAV between July 2008 and January 2013 were evaluated. Patients were divided into the in-extremis group (defined by the presence of two or more of the following organ dysfunctions: mechanical ventilation, hemodynamic instability, dialysis, coagulopathy or severe hepatic dysfunction) and the control group, which included the remaining patients. Results: A total of 19 patients underwent BAV. The clinical condition in-extremis was present in 42.1% of them. Patients from the in-extremis group had a higher EUROSCORE II (41.1 ± 24.7 vs. 15.9 ± 14.0; P = 0.001) and LV ejection fraction lower than the control group (33.9 ± 17.3% vs. 49.0 ± 12.5; P = 0.04). None of the patients in the in-extremis group survived past the hospitalization period,

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Aortic Valvuloplasty and Large‐Bore Percutaneous Arterial Access

Tomey

Kini

Sharma

et al. 2016

Interventional Cardiology

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Emerging indications, in-hospital and long-term outcome of balloon aortic valvuloplasty in the transcatheter aortic valve implantation era

Cited by 85 publications

References 21 publications

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

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

Valvuloplastia aórtica por cateter balão na estenose aórtica degenerativa: impacto terapêutico em pacientes em condição clínica in extremis

Aortic Valvuloplasty and Large‐Bore Percutaneous Arterial Access

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