Percutaneous balloon aortic valvuloplasty: Antegrade transseptal vs. conventional retrograde transarterial approach

• Published in: Catheterization and cardiovascular interventions Vol. 64; no. 3; pp. 314 - 321
• Main Authors: Sakata, Yoshihito, Syed, Zubair, Salinger, Michael H., Feldman, Ted
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.03.2005
• Subjects: Age Factors; Aged; Aged, 80 and over; aortic stenosis; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - therapy; Catheterization - instrumentation; Catheterization - methods; Catheterization - mortality; Echocardiography, Transesophageal; Equipment Design; Female; Femoral Artery; Femoral Vein; Follow-Up Studies; Heart Septum; Humans; Male; Palliative Care - methods; Retrospective Studies; Risk Factors; Survival Rate; Treatment Outcome; valvuloplasty
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.20300

Percutaneous balloon aortic valvuloplasty (BAV) has been limited predominantly to a palliative treatment for poor surgical candidates with critical aortic stenosis and multiple high‐risk or comorbid conditions. The most commonly used technique for BAV is the retrograde approach, in which the balloon is passed via the femoral artery using 12–14 Fr sheaths. We compared an antegrade transseptal approach using the Inoue balloon vs. the retrograde transarterial approach using conventional balloons. The antegrade group had an improved acute hemodynamic outcome, including 20% additional increase of aortic valve area and 20% greater reduction of transaortic valve gradient compared to the retrograde approach. Preclosure with the Perclose device was used for the 14 Fr venous access sites, resulting in immediate hemostasis, minimizing the need for transfusion, and diminishing the period of bed rest. The improved acute efficacy and relative ease of venous access for the antegrade approach facilitate BAV by eliminating the need for large‐caliber arterial access sheaths. The antegrade approach also incorporates technical elements necessary for percutaneous aortic valve replacement and may have expanded applications as an adjunct to this developing therapy. The impact of improved acute results on the long‐term clinical outcome for this patient group will require further study. Catheter Cardiovasc Interv 2005;64:314–321. © 2005 Wiley‐Liss, Inc.