Clinical outcomes following balloon aortic valvuloplasty

• Published in: Open heart Vol. 7; no. 2; p. e001330
• Main Authors: Bularga, Anda, Bing, Rong, Shah, Anoop Sv, Adamson, Philip D, Behan, Miles, Newby, David E, Flapan, Andrew, Uren, Neal, Cruden, Nick
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group 01.09.2020
• Series: Original research
• Subjects: Aged; Aged, 80 and over; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - therapy; Balloon Valvuloplasty - adverse effects; Balloon Valvuloplasty - mortality; Female; Hemodynamics; Humans; Male; Recovery of Function; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Time Factors; Treatment Outcome; Valvular Heart Disease; valvuloplasty; percutaneous valve therapy; aortic valve disease
• ISSN: 2053-3624; 2053-3624
• DOI: 10.1136/openhrt-2020-001330

Balloon aortic valvuloplasty (BAV) remains a treatment option for the selected patients with severe aortic stenosis. We examined clinical outcomes and predictors of prognosis in patients undergoing BAV for severe aortic stenosis. We identified all patients undergoing BAV from January 2010 to March 2018 (n=167) at a single transcatheter aortic valve implantation (TAVI) centre. Patient demographics, investigations, subsequent interventions and clinical outcomes were obtained from electronic health records. Patients undergoing BAV were elderly (median age 80, IQR 73-86 years) and half (n=87, 52%) were male. All-cause mortality at 30 days and 12 months was 11% and 43%, respectively. Reduce ejection fraction (EF 30%-50%: HR 1.76, 95% CI 1.05 to 2.94; EF <30%: HR 1.90, 95% CI 1.12 to 3.20) was the only independent predictor at baseline of overall mortality. Median survival was 212 (IQR 54-490) days from the index procedure. Mortality at 1 year was lowest in patients who subsequently underwent TAVI or SAVR but high among those who had no further interventions or those who had a repeat BAV (14%, 19%, 60%, 89% respectively, log-rank p<0.001). BAV as a bridge to definitive aortic valve intervention in carefully selected patients offers acceptable outcomes. These contemporary observational findings demonstrate the ongoing potential utility of BAV in the TAVI era.