Rescue aortic valvuloplasty for severe aortic stenosis is simple and effective in severely hemodynamically compromised patients presenting to centers without on-site heart surgery or TAVI facilities.

Abstract

Management of high-risk patients with severe aortic stenosis (AS) is a challenging issue. The prognosis of patients with AS presentingwiththerapy-refractory pulmonaryedema (RPE)or cardiogenic shock (CS) remains poor. The purpose of this study was to assess the 30-day mortalityof rescue percutaneous balloon aortic valvuloplasty (PBAV)in AS patients presentingwithRPEor CSina community-based hospital without on-site heart surgery. From January 2016 to February 2019,we identified consecutively admittedpatients with CS or RPE related tosevere ASwho underwent emergent PBAV. The primary end point was 30-day mortality. Secondary end points included procedural adverse events according to the Valve Academic Research Consortium (VARC)-2 criteria and predictive factors of the primary end point. We identified 51 patients with either CS (n = 22) or RPE (n = 29). All PBAV procedures were successful with a significant reduction in peak-to-peak gradient (median, [IQR] from 40 [27] mmHg to 15 [20] mmHg, p < 0.001). No procedural deaths occurred, while adverse events included stroke (4%), minor vascular complications (6%), minor (4%) and major bleedings (4%), and no life-threatening bleeding. Overall, 15 deaths (29%) were noted at 30days after PBAV, while 53% of the surviving patientswere successfully bridged to transcatheter aortic valve implantation (TAVI). 30-day mortality was significantly higher in the CS group compared to the RPE (n = 10 (45%) vs n = 5 (7%), p = 0.029), and was significantly associated with the presence of acute kidney injury (OR 9.09, 95% CI 2.13-38.77, p = 0.003) and elevated pulmonary artery systolic pressure (OR 1.06, 95% CI 1.0-1.12, p = 0.047). Rescue PBAV in patients with severe AS presenting withRPEor CSis a feasible and effective therapeutic option,even in a community-based hospital without on-site heart surgery. Rescue PBAVresultedin 30-day survival of more than 70%, with more than half of the surviving patientshaving been successfully bridged to TAVI.