450 Balloon Aortic Valvuloplasty Alone Compared to Medical Therapy is Associated With Improved Long-Term Survival in Patients With Severe Aortic Stenosis

Abstract

The role of balloon aortic valvuloplasty (BAV) has been questioned in an era of transcatheter aortic valve implantation (TAVI). Whether BAV alone is associated with improved outcomes when compared to medical management of patients with severe aortic stenosis (AS) is unclear. We assessed consecutive patients with echocardiographic evidence of severe AS between 2015-19. Patients were grouped according to the management instituted as determined by the multidisciplinary Heart Team decision; either BAV or medical management. The primary outcome was long-term all-cause mortality. Among the 187 patients with severe AS, 139 (74.3%) underwent medical management while 48 (25.7%) underwent BAV. Patients undergoing BAV were older (81.7 vs 85.8 years, p=0.01) and more likely to be female (33.3% vs 18.6%, p=0.02). No differences in individual covariates of the STS-PROM score or functional characteristics including living/mobility status or cognitive impairment were noted. 77(41.6%) deaths occurred over the study period. Patients treated with BAV had a significantly lower chance of death compared to those managed medically (HR 0.46, 95% CI 0.25-0.86, figure), even after adjustment for significant univariate clinical and functional predictors. In severe AS, BAV was independently associated with lower mortality when compared to medical therapy despite being performed in older patients. Due to limitations in access to TAVI, studies are warranted to assess whether BAV as opposed to medical therapy, can reduce wait-list mortality.