Percutaneous balloon aortic valvuloplasty (BAV) as a bridge to surgical aortic valve (SAVR) replacement in patients with severe aortic stenosis presenting with congestive heart failure

Abstract

Background: Patients present with acute congestive heart failure due to severe aortic stenosis have increased mortality andmorbidity following urgent surgical aortic valve replacement. We used balloon aortic valvuloplasty (BAV) in these high risk surgical patients with a view to reduce the risk of subsequent AVR. Methods: BAV was used in 12 patients who were otherwise suitable for conventional urgent in-patient aortic valve replacement surgery for congestive heart failure. All patients had a high perioperative risk for aortic valve replacement (mean logistic EuroSCORE of 18% 12%; Society of Thoracic Surgeons [STS] score 10% 3%). Clinical and echocardiographic variables were entered prospectively into a database. Late follow-up for survival, clinical outcomes including the New York Heart (NYHA) Association functional class, and echocardiographic assessment was 100% complete. Results: A mean follow-up of 18 months 4.5 months, overall mortality was 8.3% and, 30-day mortality was 8.3% (1/12). There was 1 perioperative re sternotomy for bleeding. Mortality was due to stroke, no morbidity in any of the patients. Length of post SAVR 9 2.5 days. NYHA functional class improved from 3.4 0.4 before operation to 1.9 0.5 at late follow-up (p = 0.02). Pre BAV mean ejection fraction was 32% 8 weeks post BAV 40 12% and following SAVR 55% 8%. Time from BAV to SAVRwas 3 1.5 days in patient and 80 12 days as an out patient. No complications due to BVA. Despite modest improvement in the valve area from 0.8 cm .03 cm to 1.1 0.2 cm there was a significant symptomatic improvement allowed. 100% discharge rate before readmission for SAVR. Conclusions: BAV is useful as a bridge to surgical aortic valve replacement for treatment of patients with severe AS presenting with congestive heart failure. It is associated with good medium-term cardiac outcomes and enables patients to receive definitive therapy with low morbidity and mortality.