Balloon aortic valvuloplasty before noncardiac surgery in severe aortic stenosis: a single-center experience.

Abstract

The aim of this study is to investigate the role and short-term results of balloon aortic valvuloplasty (BAV) before noncardiac surgery in a high selected cohort of patients. Aortic stenosis is one of the most common valvular heart diseases and a well recognized risk factor for perioperative mortality. Between May 2012 and July 2013 we enrolled 15 consecutive patients with severe aortic stenosis to allow urgent major noncardiac surgery. They had been excluded from surgical aortic valve replacement and transcatheter aortic valve implantation. Fifteen patients underwent BAV as a bridge to noncardiac surgery. They were elderly (mean age 81 ± 5 years) and predominantly men (66%) with high surgery risk (mean logistic EuroSCORE: 31.1 ± 18.2%). Three patients underwent vascular surgery, five underwent thoracic surgery, five were subjected to major abdominal surgery and in the last two patients orthopedic surgery and mastectomy were performed. No adverse events were observed in the perioperative period. Six patients (40%) were in New York Heart Association class III or IV. Mean aortic valve area was 0.52 ± 0.1 cm/m; mean aortic pressure gradient was 55.6 ± 10.8 mmHg. BAV was performed successfully in all patients. The mean peak-to-peak gradient assessed by catheterization significantly reduced after BAV (from 69.0 ± 22.1 to 29.7 ± 9.3 mmHg; P < 0.0001). The echocardiographic mean gradient was also significantly improved (from 55.6 ± 10.8 to 33.8 ± 7.9 mmHg; P < 0.0001). Survival at 30 days and at 6 months' follow-up respectively was 100%. At 6 months' follow-up clinical status according to New York Heart Association class was significantly improved (P < 0.0001). BAV is well tolerated and effective in high-risk patients with severe aortic stenosis undergoing noncardiac surgery with good short-term survival. It could represent a valid choice of treatment prior to noncardiac surgery in these high-risk patients.