Abstract 18506: Echocardiographic Hemodynamic Assessment in Patients Undergoing Aortic Balloon Valvuloplasty: A Longitudinal Case Series

Abstract

Introduction: We studied the anatomical and hemodynamic impact of balloon aortic valvuloplasty (BAV) using echocardiography in patients undergoing transcatheter aortic valve replacement (TAVR) or not. Methods: Retrospectively 22 patients referred for BAV were included [84±7 years, 63% women, ejection fraction (EF): 55±15%; EF≥50% in 16]. Echocardiography was done at 3 time points: baseline, immediately after BAV, and either after TAVR or during follow-up if TAVR was not performed. Results: BAV indications were: 2 urgent non-cardiac surgery, 7 cardiogenic shock, 1 for palliation, and 13 bridged to TAVR. At baseline, the aortic valve area (AVA) was 0.7±0.1 cm2, mean transaortic pressure gradient (PG) was 41±11 mmHg, stroke volume index (SVi) was 33±10 ml/m2, transvalvular flow rate (FR) was 197±44 ml/s, and transvalvular resistance (TVR) was 118±41 dyn.s.cm-5. Immediately after BAV, AVA significantly increased (0.9±0.2 cm2, p=0.002) and PG decreased (32±8.7 mmHg, p=0.019), indicating favorable anatomic outcomes. Interestingly, SVi (36±13, p=0.372), FR (209±60 ml/s, p=0.112), and TVR (95±49 dyn.s.cm-5, p=0.112) did not change immediately after BAV (Figure 1). During follow-up, TAVR patients exhibited near normalization of all valvular profiles, while non-TAVR did not show significant changes compared to post-BAV (Figure 1). After a median follow-up of 28 months, 7 patients died, 9 had cardiac hospitalizations, 2 had strokes, and 3 had acute coronary syndromes. As expected, TAVR had a significantly lower incidence of non-fatal composite outcomes compared to non-TAVR (1 vs. 9, p=0.007). Conclusions: Our findings indicate that BAV did not lead to substantial hemodynamic improvement in terms of transvalvular flow, flow rate, or valvular resistance, which appeared to improve only with TAVR. The modest anatomical effect of BAV did not seem to justify the high clinical risk associated with the procedure.