Elective versus rescue balloon aortic valvuloplasty for critical aortic stenosis

Abstract

Background: Balloon aortic valvuloplasty (BAV) may be considered a bridge to further intervention in hemodynamically unstable patients or patients with symptomatic severe aortic stenosis (AS).

Aims: This study aimed to retrospectively compare periprocedural and in‑hospital outcomes of AS patients treated with elective BAV (group 1) and rescue BAV (group 2).

Methods: We identified 35 patients in whom BAV was performed between 2010 and 2018. Among them, 16 were treated electively (group 1) and 19 urgently (group 2).

Results: Overall, BAV resulted in a significant decrease in the mean transaortic gradient by a median (interquartile range [IQR]) value of 5 (1–10) mm Hg (P < 0.01) and the maximal transaortic gradient by a median (IQR) value of 13.5 (2.5–23.2) mm Hg (P < 0.01). Postprocedural grade II aortic regurgitation rates increased from 8.6% to 17.1% (P = 0.48). Periprocedural death occurred in 4 patients (11.4%)—all from group 2 (21%) (P = 0.1). In‑hospital death occurred in 15 patients (42.8%)—3 patients (18.7%) from group 1 and 12 patients (63.1%) from group 2 (P < 0.01). During follow‑up, a single patient underwent surgical aortic valve replacement, and transcatheter aortic valve implantation was performed in 4 individuals. A single patient died 22 months after BAV.

Conclusions: Periprocedural and in‑hospital mortality in patients with critical AS treated with BAV remains very high, especially in patients treated urgently.