Balloon aortic valvuloplasty of severe aortic stenosis in the era of TAVR

Abstract

Introduction. Balloon aortic valvuloplasty (BAV) is a percutaneous treatment option for aortic stenosis (AS). Because of early restenosis and poor long-term survival, it is used as a bridge to surgery (SAVR) or transcatheter aortic valve replacement (TAVR), in hemodinamically unstable patients or patients that require urgent non-cardiac surgery. Aim. The aim of this study was to evaluate all the BAV procedures performed in our centre in 2010 and to report our experience with BAV as a potential bridge to definitive therapy or as a palliative treatment. Methods. We retrospectively analyzed all the patients who underwent percutaneous treatment of aortic stenosis in our institution between January and December 2010. We stratified our cohort into 3 groups: BAV as a bridge to TAVR or SAVR, BAV as a final therapy and TAVR without prior BAV. We evaluated patient characteristics, echocardiographic data and peri-procedural complications in each cohort. Survival was evaluated using Kaplan-Meier analysis. Results. We included 86 high risk symptomatic patients with mean age of 82.2 ± 5.0 years and mean logistic EuroSCORE of 19.2 ± 11.8 %. After BAV we observed a significant decrease in mean transvalvular gradient (from 43.8 ± 14.4 to 33.5 ± 12.3 mmHg; p < 0.01) and a significant increase in aortic valve area after BAV (from 0.6 ± 0.2 to 0.8 ± 0.3 cm2; p < 0.01). Systolic pulmonary artery pressure, left ventricular ejection fraction and mitral regurgitation did not change significantly. Major intrahospital complications occurred in 5 patients (6.5 %), without any death related to the procedure. BAV as a bridge to TAVR had a better outcome compared with BAV alone. Conclusion. BAV is a feasible and reasonably safe approach for temporary relief of symptoms, improvement of quality of life, decrease of surgical risk prior major non-cardiac surgery or as a bridge to surgical or transcatheter aortic valve implantation in severe aortic stenosis.