Balloon Aortic Valvuloplasty Is a Safe and Effective Temporising Therapy Prior to Aortic Valve Intervention for Severe Symptomatic Aortic Stenosis

Abstract

Aim: Balloon aortic valvuloplasty (BAV) is a bridge to AVR and TAVR in patients with severe symptomatic AS. The waitlist for aortic valve intervention is increasing and BAV is a potential temporising measure until definitive treatment can be offered. Methods: We evaluated consecutive patients who underwent BAV at St Vincent's Hospital from 2011 to 2017. Demographics, risk scores, haemodynamics and indication for BAV were recorded. Safety outcomes were also obtained at six months (procedural success, major adverse events & mortality). Results: Fifty-three patients underwent BAV via the transfemoral approach. Patients were predominantly female (54.7%) with a mean age of 81.1 ± 6.6 years. These were a high-risk population (mean STS score 11.2 ± 7.2%). Procedural success was achieved in 96.2%. There was a significant reduction in peak-to-peak gradient of 33.7 ± 14.2 mmHg at catheterisation. The adverse event rates included: major vascular injury in 3 (5.6%), pacemaker insertion in 2 (3.7%), acute kidney injury in 2 (3.7%), and blood transfusion in 3 (5.6%) patients. There were no cases of CVA or death during the index admission. At 6-month follow-up there was 1 (1.8%) death. Post BAV 5 patients (9.4%) underwent SAVR, 14 (26.4%) underwent TAVR, 5 (9.4%) had a repeat BAV and 29 patients (54.7%) were treated medically. Conclusion: We have demonstrated that BAV is an effective and safe procedure in the short term as a temporising measure before definitive aortic valve intervention.