Standalone balloon aortic valvuloplasty: indications and outcomes from the UK in the transcatheter valve era

Muhammed Z Khawaja, Manav Sohal, Haseeb Valli, Rafal Dworakowski, Stephen J Pettit, David Roy, James Newton, Heiko Schneider, Ganesh Manoharan, Sagar Doshi, Douglas Muir, David Roberts, James Nolan, Mark Gunning, Cameron Densem, Mark S Spence, Saqib Chowdhary, Vaikom S Mahadevan, Stephen J Brecker, Philip Maccarthy, Michael Mullen, Rodney H Stables, Bernard D Prendergast, Adam de Belder, Martyn Thomas, Simon Redwood, David Hildick-Smith
Catheterization and Cardiovascular Interventions 2013, 81 (2): 366-73

OBJECTIVES: We sought to characterize UK-wide balloon aortic valvuloplasty (BAV) experience in the TAVI era.

BACKGROUND: BAV for acquired calcific aortic stenosis is in a phase of renaissance, largely due to the development of transcatheter aortic valve implantation (TAVI).

METHODS: Data from 423 patients at 14 centers across the UK were analyzed.

RESULTS: Patients were aged 80.9 ± 9.5 years; 52.5% were male. Mean logistic EuroScore was 27.3% ± 16.8%. Mean peak transaortic gradient fell from 62.0 ± 26.3 to 28.3 ± 16.2 mm Hg. Aortic valve area increased from 0.58 ± 0.19 to 0.80 ± 0.25 cm(2) echocardiographically. Procedural complication rate was 6.3%, comprising death (2.4%), blood transfusion ≥ 2 U (1.2%), cardiac tamponade (1.0%), stroke (1.0%), vascular surgical repair (1.0%), coronary embolism (0.5%), and permanent pacemaker (0.2%). Mortality was 13.8% at 30 days and 36.3% at 12 months. Subsequently, 18.3% of patients underwent TAVI and 7.0% sAVR, with improved survival compared to those who had no further intervention (logrank < 0.0001). Multivariate Cox proportional hazard analysis demonstrated that survival was adversely effected by the presence of coronary artery disease (HR 1.53, 95%CI 1.08-2.17, P = 0.018), poor LV function (HR 1.54, 95%CI 1.09-2.16, P = 0.014), and either urgent (HR 1.70, 95%CI 1.18-2.45; P = 0.004) or emergent presentation (HR 3.72, 95%CI 2.27-6.08; P < 0.0001).

CONCLUSION: Balloon aortic valvuloplasty offers good immediate hemodynamic efficacy at an acceptable risk of major complications. Medium-term prognosis is poor in the absence of definitive therapy.

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