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Published on: December 11, 2017
Current results of balloon aortic valvuloplasty in high-risk patients
Shahrzad Shareghi1, Leila Rasouli, David M Shavelle
1Division of Cardiology, Good Samaritan Hospital, 1225 Wilshire Boulevard, Los Angeles, CA 90017, USA.
Insights
Balloon aortic valvuloplasty (BAV) offers acceptable outcomes for severe aortic stenosis patients unsuitable for surgery. This high-risk group, including those in cardiogenic shock, showed manageable procedural safety and long-term results with BAV.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Cardiology
Background:
- Severe aortic stenosis (AS) poses significant risks, especially for patients ineligible for surgical valve replacement.
- Balloon aortic valvuloplasty (BAV) is an alternative for high-risk or inoperable AS patients.
Purpose of the Study:
- To evaluate the contemporary outcomes of balloon aortic valvuloplasty (BAV) in severe aortic stenosis patients deemed unsuitable for surgery.
- To assess the safety and efficacy of BAV in a high-risk patient cohort, including those with cardiogenic shock.
Main Methods:
- Retrospective analysis of 80 consecutive patients with severe symptomatic AS undergoing 104 BAV procedures.
- Collection of demographic, hemodynamic, procedural data, operative risk (EuroSCORE), and long-term follow-up (mean 3+/-2 years).
Main Results:
- No procedural deaths and 9% vascular complications were observed.
- In-hospital, 1-, 2-, and 3-year mortality rates were 6%, 44%, 62%, and 71%, respectively.
- Repeat BAV procedures (21%) showed similar long-term mortality to single procedures.
Conclusions:
- Contemporary BAV demonstrates acceptable short- and long-term results for severe AS patients unsuitable for surgery.
- BAV is an effective treatment option for the highest-risk patients, including those with cardiogenic shock.
Abstract:
In this report, we describe our experience with a contemporary series of patients with severe aortic stenosis (AS) undergoing balloon aortic valvuloplasty (BAV) who were not deemed to be surgical candidates. Demographic, hemodynamic and procedural data, operative risk (EuroSCORE) and long-term follow up were collected. Eighty consecutive patients with severe symptomatic AS underwent 104 BAV procedures as a single center and were followed for a mean of 3+/-2 years. Thirteen patients underwent 2 BAV procedures, 2 patients underwent 3 BAV procedures and 1 patient underwent 5 BAV procedures. Mean age was 81+/-10 years, and 23% were >90 years of age. Cardiogenic shock was present in 20% and the ejection fraction was <30% in 38% of the patients. The mean EuroSCORE was 16+/-5, and 98% had a high-risk EuroSCORE. There were no procedural deaths and 9 (9%) total vascular complications. In-hospital, 1-, 2- and 3-year mortality rates were 6%, 44%, 62% and 71%, respectively. Seventeen patients (21%) underwent repeat BAV procedures and had long-term mortality similar to those undergoing a single BAV procedure. Contemporary BAV has acceptable short- and long-term results and can effectively be used for patients deemed unsuitable surgical candidates and those at highest operative risk, such as patients with cardiogenic shock.