Aortic balloon valvuloplasty outcome according to calcium distribution and valve geometry - The ABCD study
Gianni Dall'Ara1, Sara Piciucchi2, Carolina Moretti3
1Cardiology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy.
Insights
Balloon aortic valvuloplasty (BAV) success depends on balloon size relative to aortic annulus dimensions and inversely on calcium burden. Using the minimum annulus diameter for balloon sizing can improve BAV outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Imaging
Background:
- Limited data exists on balloon aortic valvuloplasty (BAV) outcomes related to aortic valve dimensions and calcification.
- Standardization of BAV procedures, especially balloon sizing, is lacking.
Purpose of the Study:
- To analyze the relationship between balloon size, aortic annulus geometry, and calcification patterns in BAV.
- To evaluate the efficacy and safety of BAV based on these parameters.
Main Methods:
- Retrospective multicenter study of 115 patients undergoing BAV (March 2018-March 2023).
- Analysis of ECG-gated multidetector computed tomography for valve dimensions and calcification.
- Calculation of calcium score using a +100 HU threshold on contrast-enhanced images.
Main Results:
- Procedural success rate was 82.6%.
- Higher balloon-to-annulus ratio (BAR) correlated with successful BAV.
- Higher calcium burden was observed in unsuccessful BAV cases.
- Complication rate was 4.3% with no association to valve geometry or calcium burden.
- BAR minimum annulus diameter (cut-off 0.85) best predicted procedural success.
Conclusions:
- BAV efficacy is directly related to balloon size relative to annulus dimensions and inversely to total calcium burden.
- Minimum aortic valve diameter is a reliable reference for optimizing balloon sizing in BAV.
Background:
There is little data on the outcome of balloon aortic valvuloplasty (BAV) in relation to valve dimensions and calcification patterns. The procedure is not standardized, particularly the choice of balloon size.
Methods:
This retrospective multicenter study focused on BAV efficacy and safety by analyzing the relationship between balloon size, annulus geometry (i.e., diameters, perimeter, and area), and calcification patterns (total burden and calcium distribution over each individual leaflet). From March 2018 to March 2023, all consecutive patients who underwent clinically indicated BAV and ECG-gated multidetector computed tomography of the aorta were included, except those with a bicuspid valve. Calcium score was calculated on contrast-enhanced images based on a luminal attenuation threshold of +100 HU.
Results:
One hundred and fifteen patients were included. Procedural success was 82.6 %. The balloon-to-annulus ratio (BAR) relative to diameter, perimeter, and area was higher in patients with successful BAV. Patients with unsuccessful BAV had a significantly higher aortic valve calcium burden. The complication rate was 4.3 % and there was no association with valve geometry or calcium burden. A trend towards a reduced complication rate was found as calcium asymmetry increased. BAR minimum annulus diameter was the best parameter in predicting procedural success, with a cut-off at 0.85.
Conclusions:
BAV efficacy is correlated directly with balloon size in relation to annulus dimension and inversely with total calcium burden. The minimum diameter of the valve may be adopted as a reference for balloon sizing.
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