Percutaneous Balloon Aortic Valvuloplasty: A New Look at an Old Procedure

Sharifi, Mohsen; Parhizgar, Alireza; Mehdipour, Mahshid; Hodge, Mark; Neckels, Brenda; Emrani, Farnaz

doi:10.1177/0003319706295518

Cited by 3 publications

(3 citation statements)

References 7 publications

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“…Recent data on BAV suggest that technical and procedural advances have decreased procedural complication rates in high‐risk patients, suggesting that increased utilization of the procedure is warranted in the growing subset of patients with limited therapeutic options [8–11]. As such, BAV is currently used as a palliative procedure for high‐risk patients who are precluded from surgical AVR or as a bridge to surgery in hemodynamically unstable patients [2].…”

Section: Introductionmentioning

confidence: 99%

A novel clinical prediction rule for 30‐day mortality following balloon aortic valuloplasty: The CRRAC the AV score

Elmariah

Lubitz

Shah

et al. 2011

Cathet Cardio Intervent

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Objectives We seek to identify predictors of 30-day mortality after balloon aortic valvuloplasty (BAV). Background To date, there is no validated method of predicting patient outcomes after percutaneous aortic valve interventions. Methods Data for consecutive patients with severe aortic stenosis who underwent BAV at the Mount Sinai Medical Center from January 2001 to July 2007 were retrospectively reviewed. Cox proportional hazards regression was used to identify significant predictors of 30-day mortality and the resultant model was compared to the EuroSCORE using Akaike's Information Criterion and area under the receiver-operating curve (AUC). Results The analysis included 281 patients (age 83 ± 9 yrs, 61% women, aortic valve area: 0.64 ± 0.2 cm2), 36 (12.8%) of whom died within 30 days of BAV. Identified risk factors for 30-day mortality, critical status, renal dysfunction, right atrial pressure, and cardiac output, we used to construct the CRRAC the AV risk score. Thirty-day survival was 72% in the highest tertile versus 94% in the lower two tertiles of the score. Compared to the additive and logistic EuroSCORE, the risk score demonstrated superior discrimination (AUC = 0.75 vs. 0.60 and 0.63, respectively). Conclusions We derived a risk score, the CRRAC the AV score, that identifies patients at high-risk of 30-day mortality after BAV. Validation of the developed risk prediction score, the CRRAC the AV score, is needed in other cohorts of post-BAV patients and potentially in patients undergoing other catheter-based valve interventions.

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Section: Introductionmentioning

confidence: 99%

A novel clinical prediction rule for 30‐day mortality following balloon aortic valuloplasty: The CRRAC the AV score

Elmariah

Lubitz

Shah

et al. 2011

Cathet Cardio Intervent

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“…The only serious complication experienced in the current series of 20 patients during the first 24 hours after BAV was tamponade in 1 patient. In two previous large series of patients undergoing BAV, cardiac tamponade was reported in 3 of 170 consecutive patients (1.8%) 6 and 10 of 672 patients (1.5%) 3…”

Section: Resultsmentioning

confidence: 91%

“…A recently published case report suggested that using small profile peripheral balloons may reduce complications, with a patient successfully treated using an 8‐French (F) arterial sheath 6 . The current report describes a case series of consecutive patients with severe aortic stenosis referred for BAV and treated in routine clinical practice using a valvuloplasty technique developed by the first author and designed to optimize valve opening while also improving procedure safety.…”

Section: Introductionmentioning

confidence: 99%

Balloon Aortic Valvuloplasty for Aortic Stenosis Using a Novel Percutaneous Dilation Catheter and Power Injector

Eles

Fisher

Khalil

et al. 2010

Journal of Interventional Cardiology

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Calcific aortic stenosis is the most common valvular heart disease in the Western world. Although definitive treatment is valve replacement, many patients are not replacement candidates due to high surgical risk from older age and comorbid illness or lack of desire for a surgical or replacement procedure. Percutaneous balloon aortic valvuloplasty (BAV) is an option for palliative treatment in nonsurgical patients, although this procedure is complicated during the immediate postprocedure period by bleeding requiring transfusion for about 1 in 5 patients and subsequent restenosis. This report describes BAV using a smaller profile balloon designed to withstand higher pressures, rapidly inflated with a power injector. Twenty consecutive high-risk patients with severe aortic stenosis were treated. In all cases, New York Heart Association (NYHA) class improved from IV before BAV to I or II at 30 days follow-up. Six-month posttreatment follow-up data were available for 19 of 20 patients: 15 patients were either NYHA class I or II, 1 patient was class III, and 3 deaths occurred unrelated to aortic stenosis. One patient was lost to follow-up. Average systolic gradient peak-to-peak pressure decreased by 40.0% (range 18.0-70.0%) and mean gradient decreased by 30.0% (range 13.7-70.8%). Aortic valve area increased from 0.59 ± 0.16 cm(2) to 0.92 ± 0.23 cm(2), representing a mean increase of 30.0% (range 7.8%-58.2%). There were no significant bleeding complications. The only procedural complication was a single case of pericardial tamponade. There were no other complications during the first 24 hours post-BAV. These data support that the reported BAV technique may offer an effective alternative for patients with severe aortic stenosis who are not surgical candidates or prefer to avoid aortic valve replacement.

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