155 Percutaneous aortic balloon valvuloplasty as first-line treatment in high-risk patients scheduled for transcatheter aortic valve implantation

Abstract

To assess the results of first-line percutaneous aortic balloon valvuloplasty (PABV) in high-risk patients referred for transcatheter aortic valve implantation (TAVI) Methods: Of 253 high-risk patients referred for TAVI between October 2006 and September 2009, 41 were considered transiently unsuitable for either aortic valve replacement (AVR) or TAVI and underwent PABV as potential bridge to intervention. In the others, primary TAVI or AVR was performed in 140 cases, and medical therapy alone in 72. Indications for PABV were: unstable haemodynamic condition (n = 27, of whom 12 cardiogenic shocks), TAVI not immediately available for logistic reasons (n = 6), associated cancer requiring further explorations (n = 4), therapeutic test for contentious presentation (n = 3), combined acute coronary syndrome requiring urgent percutaneous revascularization (n = 1). No death occurred during PABV. Twenty-three patients actually underwent secondary TAVI (n = 19) or AVR (n = 4) (bridge PABV), while 18 did not undergo further intervention (PABV alone) because of technical (n = 10) or general (n = 5) contraindications, death before intervention (n = 2) or patient's refusal (n = 1). The main baseline characteristics and clinical outcomes of the different subgroups are presented in the Table. There was no significant difference in one-year survival between the primary TAVI/AVR and bridge PABV groups (p = 0.08), and between the medical treatment and PABV alone groups (p = 0.36). In very high-risk patients with aortic stenosis and temporary contraindications to AVR or TAVI, 1) PABV may be used as a bridge to intervention with good mid-term outcomes, 2) PABV alone can be safely performed but is associated with a poor mid-term outcome. Bridge PABV (n = 23) PABV alone (n = 18) Primary TAVI or AVR (n = 140) Medical treatment (n = 72) Age (years) 79 ± 8 83 ± 8 82 ± 8 83 ± 9 EuroSCORE (%) 35 ± 21 39 ± 24 25 ± 12 31 ± 17 Hospital survival (%) 100 67 88 86 One-year survival (%) 94 ± 5 33 ± 11 74 ± 4 30 ± 6