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Balloon aortic valvuloplasty for aortic stenosis using a novel percutaneous dilation catheter and power injector
Gustav R Eles1, Don L Fisher, Ramzi Khalil
1Division of Cardiology, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA. drgeles@aol.com
Insights
A new balloon aortic valvuloplasty (BAV) technique improved symptoms and heart function in high-risk patients with severe aortic stenosis, offering a safer alternative to surgery with reduced bleeding complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Valvular Heart Disease
Background:
- Calcific aortic stenosis is a prevalent valvular heart disease.
- Definitive treatment involves valve replacement, but many patients are inoperable due to age, comorbidities, or preference.
- Percutaneous balloon aortic valvuloplasty (BAV) offers palliative care for nonsurgical candidates but has risks like bleeding and restenosis.
Observation:
- A novel BAV technique using a smaller, high-pressure balloon inflated rapidly was employed.
- Twenty high-risk patients with severe aortic stenosis underwent the procedure.
- The technique aimed to mitigate complications associated with traditional BAV.
Findings:
- All patients showed improved New York Heart Association (NYHA) functional class from IV to I or II within 30 days.
- Six-month follow-up revealed sustained improvement in most patients, with 15 in NYHA class I or II.
- Significant reductions in systolic and mean gradients were observed, alongside a 30% increase in aortic valve area.
- Notably, there were no significant bleeding complications, with only one case of pericardial tamponade as the procedural complication.
Implications:
- This refined BAV technique demonstrates potential as an effective alternative for severe aortic stenosis patients unsuitable for surgery.
- The reduced complication rate, particularly bleeding, enhances its safety profile.
- Further research may validate this approach for broader clinical application in high-risk populations.
Abstract:
Calcific aortic stenosis is the most common valvular heart disease in the Western world. Although definitive treatment is valve replacement, many patients are not replacement candidates due to high surgical risk from older age and comorbid illness or lack of desire for a surgical or replacement procedure. Percutaneous balloon aortic valvuloplasty (BAV) is an option for palliative treatment in nonsurgical patients, although this procedure is complicated during the immediate postprocedure period by bleeding requiring transfusion for about 1 in 5 patients and subsequent restenosis. This report describes BAV using a smaller profile balloon designed to withstand higher pressures, rapidly inflated with a power injector. Twenty consecutive high-risk patients with severe aortic stenosis were treated. In all cases, New York Heart Association (NYHA) class improved from IV before BAV to I or II at 30 days follow-up. Six-month posttreatment follow-up data were available for 19 of 20 patients: 15 patients were either NYHA class I or II, 1 patient was class III, and 3 deaths occurred unrelated to aortic stenosis. One patient was lost to follow-up. Average systolic gradient peak-to-peak pressure decreased by 40.0% (range 18.0-70.0%) and mean gradient decreased by 30.0% (range 13.7-70.8%). Aortic valve area increased from 0.59 ± 0.16 cm(2) to 0.92 ± 0.23 cm(2), representing a mean increase of 30.0% (range 7.8%-58.2%). There were no significant bleeding complications. The only procedural complication was a single case of pericardial tamponade. There were no other complications during the first 24 hours post-BAV. These data support that the reported BAV technique may offer an effective alternative for patients with severe aortic stenosis who are not surgical candidates or prefer to avoid aortic valve replacement.