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Am Heart J. 2014 Feb;167(2):235-40. doi: 10.1016/j.ahj.2013.10.019. Epub 2013 Nov 4.

Balloon aortic valvuloplasty in the era of transcatheter aortic valve replacement: acute and long-term outcomes.

Author information

1
Department of Cardiology, University Hospital of Rouen, Hospital Charles Nicolle, INSERM U1096, Rouen, France. Electronic address: helene.eltchaninoff@chu-rouen.fr.
2
Department of Cardiology, University Hospital of Rouen, Hospital Charles Nicolle, INSERM U1096, Rouen, France.
3
Department of Interventional Cardiology, Wellmont CVA Heart Institute, Kingsport, TN.

Abstract

BACKGROUND:

The use of balloon aortic valvuloplasty (BAV) has resurged since the development of transcatheter aortic valve replacement (TAVR). The aim of our study was to determine the procedural and long-term outcomes of patients treated by BAV in the early TAVR era.

METHODS:

From 2005 to 2008, 323 consecutive patients presenting with severe aortic stenosis were treated by BAV in our institution.

RESULTS:

Mean age and logistic EuroSCORE were 80.5 ± 9.9 years and 28.7% ± 12.5%, respectively. The effective orifice area increased from 0.68 ± 0.25 to 1.12 ± 0.39 cm(2) (P < .001) after BAV. Inhospital major complications occurred in 22 patients (6.8%), with a mortality rate of 2.5%. Eighty-five patients (26.3%) were bridged to surgical aortic valve replacement (SAVR, 9.6%) or TAVR (16.7%). Twenty-eight patients (8.7%) had at least 1 repeat BAV. Two hundred ten patients (65%) received only medical therapy post-BAV. Mean duration of follow-up was 20.7 ± 20.0 months. Kaplan-Meier analysis demonstrated that survival after single BAV was poor. Patients treated by BAV followed by SAVR or TAVR had the highest long-term survival rate (P < .001). Multivariable analysis revealed that logistic EuroSCORE, severe aortic regurgitation and stroke complications post-BAV, and medical therapy post-BAV were independent predictors of mortality.

CONCLUSIONS:

The results of our study suggest that BAV is an acceptable bridge to SAVR or TAVR in a very high-risk population not immediately suitable for definitive therapy. Balloon aortic valvuloplasty remains only a brief temporizing procedure with a poor long-term outcome without subsequent definitive therapy.

PMID:
24439985
DOI:
10.1016/j.ahj.2013.10.019
[Indexed for MEDLINE]
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