Balloon Aortic Valvuloplasty

Abstract

When balloon aortic valvuloplasty (BAV) was first developed 30 years ago, it offered an alternative to conventional surgical aortic valve replacement in elderly and frail patients for whom there were no other effective options. Initial excitement at its dramatic hemodynamic and symptomatic benefits was tempered when it was established that the hemodynamic improvement was short lived with rapid restenosis, and patients had the same very poor outcome as those with untreated severe aortic stenosis.1–4 More recently, in the PARTNER study (Placement of Aortic Transcatheter Valve), which defined the start of the transcatheter aortic valve replacement (TAVR) era, most patients randomized to standard treatment underwent BAV. Again, there was an initial improvement in symptoms and survival compared with patients not undergoing BAV, but after 1 year, there was no difference between the groups.5 Despite these findings, BAV has staged a resurgence in recent years, as a standalone palliative therapy in patients unfit for surgery or as a bridge to definitive treatment with TAVR or conventional surgical aortic valve replacement. It is important that we understand why BAV use has increased, and whether this increase is justified. See Article by Alkhouli et al In this issue of Circulation: Cardiovascular Interventions , Alkhouli et al6 provide a timely update on the utilization and outcomes of BAV using data from the National Inpatient Sample, a database of US hospital discharges from hospitals from the Healthcare Cost and Utilization project. They analyze BAV use and outcomes over 10 years (2004–2013) which include the beginning of the TAVR era. The authors addressed 3 important …