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Balloon Aortic Valvuloplasty with or without Percutaneous Coronary Intervention in the Transcatheter Aortic Valve

Omar Aldalati1,2, Matthew Jackson1, Seth Vijayan1

  • 1Cardiothoracic Department, The James Cook University Hospital, Middlesbrough, UK.

Cardiology
|March 25, 2024
PubMed

Insights

Combined balloon aortic valvuloplasty and percutaneous coronary intervention (BAV-PCI) is safe and feasible for high-risk patients with aortic valve stenosis. Outcomes were comparable to BAV alone, with no significant differences in mortality.

Area of Science:

  • Interventional Cardiology
  • Cardiovascular Medicine
  • Structural Heart Disease

Background:

  • Balloon aortic valvuloplasty (BAV) remains a debated option for aortic valve stenosis (AS) in the era of transcatheter aortic valve replacement (TAVR).
  • The safety and feasibility of combining BAV with percutaneous coronary intervention (PCI) are not well-established.

Purpose of the Study:

  • To evaluate the safety and feasibility of combined BAV and PCI (BAV-PCI).
  • To compare procedural outcomes and mortality in patients undergoing BAV with or without concurrent PCI.

Main Methods:

  • Retrospective study of 264 patients undergoing BAV from November 2009 to July 2020.
  • Patients were divided into three groups: combined BAV-PCI (Group A), BAV with unrevascularized CAD (Group B), and BAV without significant CAD (Group C).
  • Procedural complications (VARC-3 criteria) and 30-day/one-year mortality were compared across groups.

Main Results:

  • No significant differences in VARC-3 adjudicated complications were observed among the three groups (11% vs. 13% vs. 5%, p=0.168).
  • Overall 30-day and one-year mortality were 9.8% and 32%, respectively, with no statistically significant differences between groups.
  • Univariate analysis indicated higher mortality risk in Group B (BAV with unrevascularized CAD) compared to Group A (BAV-PCI) (HR 1.58, p=0.010).
  • Multivariate analysis identified STS score, cardiogenic shock, presentation mode, and lack of definitive valve intervention as predictors of mortality.

Conclusions:

  • Combined BAV-PCI is a safe and feasible strategy in high-risk patients with aortic valve stenosis.
  • The procedure is associated with comparable outcomes to BAV performed with or without significant coronary artery disease.
  • Key predictors of mortality include STS score, cardiogenic shock, presentation, and absence of subsequent definitive valve intervention.
Abstract

Keywords:
Acute coronary syndromeAortic valve stenosisBalloon aortic valvuloplastyCombined proceduresPercutaneous coronary intervention

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