Abstract P162: Percutaneous Balloon Aortic Valvuloplasty: A Single-Center Experience of 357 Patients Over 10 Years

Abstract

Background: Percutaneous balloon aortic valvuloplasty (PBAV) is primarily used as a palliative therapeutic option for relief of severe aortic stenosis (AS) in patients who are poor candidates for definitive surgical therapy. The rationale for limited use of PBAV in severe AS is due to poor durability and high rates of recurrence in early studies. This study describes the largest published single-center experience of PBAV with current day outcomes. Methods: We reviewed the last ten years of all patients that underwent PBAV at Deborah Heart and Lung Center totaling 357 patients. Extensive pre- and post-procedural data were tabulated on the last 100 patients, from October 2006 to January 2010, as a preliminary screening to determine current day outcomes with PBAV. Number of balloon inflations, mean gradients pre- and post-procedure, change in mean gradients, duration until repeat PBAV or surgical valve replacement, and mortality were all recorded and evaluated for correlation with outcomes. Results: Of the last 100 patients, there were no hospital or procedure-related deaths, strokes, or emergent cardiac surgery. Mean gradients (MG) across the aortic valve improved from 38.5 mmHg to 19.2 mmHg with an average change in mean gradient (ΔMG) of 19.1 mmHg. The number of inflations peformed during PBAV correlated to increase in ΔMG (1 inflation = 17.4 mmHg ΔMG; >2 inflations = 20.0 mmHg ΔMG; >3 inflations = 20.9 mmHg ΔMG). The number of inflations also correlated to an increased duration until repeat PBAV (1 inflation = 7.9 months; >2 inflations = 10.4 months; >3 inflations = 11.3 months). The average ΔMG among those that required repeat PBAV was 20.9 mmHg. The ΔMG was further linked to duration until repeat PBAV such that when ΔMG < 20 mmHg, duration to PBAV = 8.7 months and when ΔMG > 20 mmHg, duration to PBAV = 10.8 months. The mortality rate after PBAV was 10% with an average ΔMG within this subset of 21.5 mmHg. Conclusions: PBAV, although transient, provides a relatively modest improvement in valve function and continues to be safe and feasible in experienced hands for patient subsets that are high risk for surgery. Additional inflations during PBAV and ΔMG > 20 mmHg result in better long-term outcomes and need to be further evaluated in larger prospective studies.