Balloon aoric valvuloplasty of severe aoric stenosis in the era of TAVR

P. Kogoj1, T. Furlan2, m. Bunc1
1Department of Cardiology, Division of Internal Medicine, University Medical Centre Ljubljana, Slovenia 2Department of Internal Medicine, General Hospital Jesenice, Slovenia

Introducion. Balloon aoric valvuloplasty (BAV) is a percutaneous treatment opion for aoric stenosis (AS). Because of early restenosis and poor long-term survival, it is used as a bridge to surgery (SAVR) or transcatheter aoric valve replacement (TAVR), in hemodinamically unstable paients or paients that require urgent non-cardiac surgery.
Aim. The aim of this study was to evaluate all the BAV procedures performed in our centre in 2010 and to report our experience with BAV as a potenial bridge to deiniive therapy or as a palliaive treatment.
Methods. We retrospecively analyzed all the paients who underwent percutaneous treatment of aoric stenosis in our insituion between January and December 2010. We straiied our cohort into 3 groups: BAV as a bridge to TAVR or SAVR, BAV as a inal therapy and TAVR without prior BAV. We evaluated paient characterisics, echocardiographic data and peri-procedural complicaions in each cohort. Survival was evaluated using Kaplan-Meier analysis.
Results. We included 86 high risk symptomaic paients with mean age of 82.2 ± 5.0 years and mean logisic EuroSCORE of 19.2 ± 11.8 %. Ater BAV we observed a signiicant decrease in mean transvalvular gradient (from 43.8 ± 14.4 to 33.5 ± 12.3 mmHg; p < 0.01) and a signiicant increase in aoric valve area ater BAV (from 0.6 ± 0.2 to 0.8 ± 0.3 cm2; p < 0.01). Systolic pulmonary artery pressure, let ventricular ejecion fracion and mitral regurgitaion did not change signiicantly. Major intrahospital complicaions occurred in 5 paients (6.5 %), without any death related to the procedure. BAV as a bridge to TAVR had a beter outcome compared with BAV alone.
Conclusion. BAV is a feasible and reasonably safe approach for temporary relief of symptoms, improvement of quality of life, decrease of surgical risk prior major non-cardiac surgery or as a bridge to surgical or transcatheter aoric valve implantaion in severe aoric stenosis.




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