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Safety and efficacy of repeated balloon aortic valvuloplasty in patients with symptomatic severe aortic stenosis

Danuta Sorysz12, Artur Dziewierz12, Łukasz Rzeszutko12, Agata Wiktorowicz1, Wojciech Wojakowski3, Radosław Parma3, Agnieszka Skoczyńska3, Paweł Kleczyński45, Maciej Stąpór45, Dariusz Dudek16, Jacek Legutko45, Stanisław Bartuś12
DOI: 10.33963/KP.a2023.0021
·
Pubmed: 36648223
Affiliations
  1. Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
  2. 2nd Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
  3. Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
  4. Clinical Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
  5. Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
  6. Digital Medicine & Robotics Center, Jagiellonian University Medical College, Kraków, Poland

open access

Online first
Original article
Published online: 2023-01-17

Abstract

Background: Long-term outcomes of balloon aortic valvuloplasty (BAV) in patients with severe symptomatic aortic stenosis (AS) are poor, and this procedure needs to be repeated for selected cases.

Aims: To investigates the safety and efficacy of repeated BAV (reBAV).

Methods: We included consecutive patients who underwent reBAV in three Polish centers between 2010 and 2019. Baseline clinical, echocardiographic, procedural, and outcome data were analyzed.

Results: Thirty-five patients (median age 81.5 years, 57.1% women) who underwent reBAV were enrolled. In 42.9% of the patients, index BAV was considered a palliative treatment, and in 54.3% a bridge to definitive treatment. Index BAV decreased peak aortic valve gradient (pAVG) from a median of 78.0 mm Hg to 46.0 mm Hg (P <0.001). After a mean of 255.8 days, reBAV was performed. In most cases (71.4%), the reason for reBAV was the worsening of heart failure symptoms and in 54.3% of patients, reBAV was still considered a palliative option. A decrease in pAVG max from a median of 73.0 mmHg to 45.0 mmHg (P <0.001), comparable to the index BAV, was observed. The complications were numerically higher for repeated procedures. During the median (IQR) follow-up of 403.0 (152.0–787.0) days from the index procedure, 80.0% of the patients died.

Conclusions: Acute hemodynamic results of reBAV are comparable to those achieved during index BAV. However, reBAV may carry an increased risk of complications. Mortality after reBAV is high due to unfavorable risk profiles or delays in receiving definitive therapy.

Abstract

Background: Long-term outcomes of balloon aortic valvuloplasty (BAV) in patients with severe symptomatic aortic stenosis (AS) are poor, and this procedure needs to be repeated for selected cases.

Aims: To investigates the safety and efficacy of repeated BAV (reBAV).

Methods: We included consecutive patients who underwent reBAV in three Polish centers between 2010 and 2019. Baseline clinical, echocardiographic, procedural, and outcome data were analyzed.

Results: Thirty-five patients (median age 81.5 years, 57.1% women) who underwent reBAV were enrolled. In 42.9% of the patients, index BAV was considered a palliative treatment, and in 54.3% a bridge to definitive treatment. Index BAV decreased peak aortic valve gradient (pAVG) from a median of 78.0 mm Hg to 46.0 mm Hg (P <0.001). After a mean of 255.8 days, reBAV was performed. In most cases (71.4%), the reason for reBAV was the worsening of heart failure symptoms and in 54.3% of patients, reBAV was still considered a palliative option. A decrease in pAVG max from a median of 73.0 mmHg to 45.0 mmHg (P <0.001), comparable to the index BAV, was observed. The complications were numerically higher for repeated procedures. During the median (IQR) follow-up of 403.0 (152.0–787.0) days from the index procedure, 80.0% of the patients died.

Conclusions: Acute hemodynamic results of reBAV are comparable to those achieved during index BAV. However, reBAV may carry an increased risk of complications. Mortality after reBAV is high due to unfavorable risk profiles or delays in receiving definitive therapy.

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About this article
Title

Safety and efficacy of repeated balloon aortic valvuloplasty in patients with symptomatic severe aortic stenosis

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2023-01-17

Page views

123

Article views/downloads

26

DOI

10.33963/KP.a2023.0021

Pubmed

36648223

Authors

Danuta Sorysz
Artur Dziewierz
Łukasz Rzeszutko
Agata Wiktorowicz
Wojciech Wojakowski
Radosław Parma
Agnieszka Skoczyńska
Paweł Kleczyński
Maciej Stąpór
Dariusz Dudek
Jacek Legutko
Stanisław Bartuś

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