Balloon aortic valvuloplasty--ups and downs--are we facing a procedure comeback?

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Balloon aortic valvuloplasty (BAV) is experiencing a resurgence in clinical interest.
• Transcatheter aortic valve implantation (TAVI) has become a standard treatment for aortic stenosis.

Purpose of the Study:

• To analyze the indications for BAV.
• To evaluate the short-term outcomes of BAV following the introduction of TAVI.

Main Methods:

• A consecutive series of 25 patients undergoing BAV between September 2010 and September 2014.
• Analysis of patient demographics, comorbidities (EuroScore II, STS score), and indications for BAV.
• Assessment of in-hospital mortality, major complications, and hemodynamic changes (aortic transvalvular gradient).

Main Results:

• In-hospital mortality was 20%, primarily in patients with hemodynamically unstable heart failure.
• Major complications included pacemaker implantation (2), vascular complications (4), and cardiac tamponade (1).
• Significant reduction in mean peak aortic transvalvular gradient (96.9 to 60.3 mm Hg, p=0.0001) with no significant aortic regurgitation.

Conclusions:

• Primary indications for BAV include advanced aortic stenosis with hemodynamic instability, palliative care, and bridging to TAVI or surgical valve replacement.
• BAV offers favorable short-term outcomes with low procedural morbidity and mortality.
• High mortality is associated with BAV in hemodynamically unstable patients with cardiogenic shock or pulmonary edema.