Balloon Aortic Valvuloplasty for Severe Aortic Stenosis as Rescue or Bridge Therapy.

Pawel Kleczynski,Jacek Legutko,Aleksandra Kulbat,Artur Dziewierz,Piotr Brzychczy,Stanislaw Bartus,Danuta Sorysz,Dariusz Dudek,Maciej Stapor,Lukasz Rzeszutko,Jaroslaw Trebacz

doi:10.3390/jcm10204657

Abstract

The study aimed to assess procedural complications, patient flow and clinical outcomes after balloon aortic valvuloplasty (BAV) as rescue or bridge therapy, based on data from our registry. A total of 382 BAVs in 374 patients was performed. The main primary indication for BAV was a bridge for TAVI (n = 185, 49.4%). Other indications included a bridge for AVR (n = 26, 6.9%) and rescue procedure in hemodynamically unstable patients (n = 139, 37.2%). The mortality rate at 30 days, 6 and 12 months was 10.4%, 21.6%, 28.3%, respectively. In rescue patients, the death rate raised to 66.9% at 12 months. A significant improvement in symptoms was confirmed after BAV, after 30 days, 6 months, and in survivors after 1 year (p < 0.05 for all). Independent predictors of 12-month mortality were baseline STS score [HR (95% CI) 1.42 (1.34 to 2.88), p < 0.0001], baseline LVEF <20% [HR (95% CI) 1.89 (1.55–2.83), p < 0.0001] and LVEF <30% at 1 month [HR (95% CI) 1.97 (1.62–3.67), p < 0.0001] adjusted for age/gender. In everyday clinical practice in the TAVI era, there are still clinical indications to BAV a standalone procedure as a bridge to surgery, TAVI or for urgent high risk non-cardiac surgical procedures. Patients may improve clinically after BAV with LV function recovery, allowing to perform final therapy, within limited time window, for severe AS which ameliorates long-term outcomes. On the other hand, in patients for whom an isolated BAV becomes a destination therapy, prognosis is extremely poor.

Highlights

At present, management of severe aortic valve stenosis (AS) offers surgical or endovascular therapy depending on a patients’ risk profile and severity of clinical symptoms [1,2].Endovascular treatment includes transcatheter aortic valve implantation (TAVI) or balloon aortic valvuloplasty (BAV)
The main primary indication for BAV was a bridge for TAVI (n = 185, 49.4%)
Other indications included a primary bridge for aortic valve implantation (AVR, n = 26, 6.9%) and palliative treatment (n = 139, 37.2%)

Summary

Introduction

Endovascular treatment includes transcatheter aortic valve implantation (TAVI) or balloon aortic valvuloplasty (BAV). Balloon aortic valvuloplasty has gained importance in recent years, especially in patients who were recognized as in not optimal clinical condition for any definitive treatment due to severe comorbidities. On the contrary to TAVI, clinical and hemodynamic outcomes of BAV were shown to be relatively poor with longer follow-up period, and sometimes the procedure needs to be repeated [4,5,6,7,8]. Due to relatively low access to TAVI, BAV is still a reasonable procedure in developing countries, but such an approach remains rather controversial in light of current ESC guidelines [2]. We aimed to assess patient flow, procedural complications and clinical outcomes after BAV as rescue or bridge therapy in patients with severe symptomatic AS

Objectives

Methods

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Discussion

Conclusion