Abstract 19521: Impact of Procedural Complications on Survival in Patients with Severe Aortic Stenosis Treated with Balloon Aortic Valvuloplasty: Results from the BRAVO Study

Abstract

Introduction. Previous studies have examined the baseline predictors of survival in patients with severe aortic stenosis treated with balloon aortic valvuloplasty (BAV). However, the impact of procedural complications on long-term survival is unknown. Methods. Weconducted an independent retrospective review of pts who underwent non-emergent BAV at 2 high volume centers from 2005 to 2011. In-hospital events (bleeding, vascular complications, acute kidney injury [AKI], myocardial infarction, stroke) were adjudicated by an independent Clinical Events Committee. Survival status of all patients was ascertained by the Social Security Death Index. We compared patient survival by the occurrence of in-hospital complications. Cox regression analysis was used to adjust for significant baseline and procedural correlates of survival, in order to determine the incremental impact of in-hospital events on longer-term survival. Results. The median follow-up duration among 445 patients post BAV was 288 days. Major bleeding (defined as BARC type ≥ 3), AKI and vascular complications (per VARC definitions) were associated with increased mortality. After adjusting for baseline and procedural variables, AKI remained a strong predictor of mortality (OR 6.9, 95% CI 3.7 - 12.6, p<0.001), major bleeding was associated with a trend for increased mortality (OR 1.5, 95% CI 0.96 - 2.5, p=0.07) and vascular complications were eliminated as a predictor. By Cox methods, anemia, atrial fibrillation/flutter and high creatinine at baseline were also associated with mortality whereas rapid RV pacing and attempted “preclosure” of the access site using a suture-based closure device were associated with improved survival (all p<0.05, Figure). Conclusion. Procedural complications, in particular AKI, have significant impact on long term survival after BAV. Dedicated studies are required to examine the impact of strategies to reduce procedural complications on long term patient outcomes.