Aortic balloon valvuloplasty as a bridge-to-decision in patients with aortic stenosis

Introduction: Balloon aortic valvuloplasty (BAV) is a method of treatment for patients who are temporally ineligible for surgical aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI). This procedure allows one to select patients with severe left ventricle dysfunction or with symptoms of unknown origin who can benefit from AVR or TAVI.

Aim: To evaluate the efficacy, safety and outcome of therapy in patients treated with balloon aortic valvuloplasty. To define clinical characteristics, immediate and distant outcomes of the procedure, and factors affecting the 12-month mortality.

Material and methods: We retrospectively evaluated the procedural and clinical outcomes of 47 consecutive patients with severe, symptomatic aortic stenosis (AS) who underwent balloon aortic valvuloplasty in our center.

Results: Age and logistic EuroSCORE were 76.81 ±6.64 and 22.85 ±13.74, respectively. The mean gradient after the procedure decreased from 52.23 ±18.21 to 35.52 ±13.43 mm Hg (p = 0.001). Major complications occurred in 5 (10.6%) patients. In-hospital, 30-day and 1-year mortalities were 6.38%, 10.63% and 42.55%, respectively. 31.9% of patients underwent the destination therapy (TAVI or AVR). One-year mortality in the group treated conservatively after BAV was 56.2%, while in the group treated with AVR or TAVI it was 13.3%. Procedural success, presence of arterial hypertension, and performance of the destination therapy were factors associated with a decreased 1-year mortality.

Conclusions: Balloon aortic valvuloplasty should be treated as a bridge-to-decision on further treatment. Balloon aortic valvuloplasty has high efficacy and an acceptable adverse events rate. Patients undergoing balloon valvuloplasty are high-risk patients with many comorbidities.