Balloon Aortic Valvuloplasty for Severe Aortic Stenosis as a Bridge to Transcatheter/Surgical Aortic Valve Replacement

Objectives: This study aimed to determine success- and complication rates after balloon aortic valvuloplasty (BAV) and the outcome of BAV as a standalone therapy versus BAV as a bridge to transcatheter/surgical aortic valve replacement (T/SAVR). Background: The introduction of transcatheter aortic valve replacement (TAVR) has led to a revival in BAV as treatment for patients with severe aortic stenosis. Methods: A cohort of 472 patients underwent 538 BAV procedures. The cohort was divided into two groups: BAV alone 387 (81.9%) and BAV as a bridge 85 (18.1%) to (n = 65, TAVR; n = 20, surgery). Clinical, hemodynamic, and follow-up mortality data were collected. Results: There was no significant difference between the two groups in mean age (81.7 +/- 8.3 vs. 83.2 +/- 10.9 years, P = 0.18), society of thoracic surgeons score (13.1 +/- 6.2 and 12.4 +/- 6.4, P = 0.4), logistic EuroSCORE (45.4 +/- 22.3 vs. 46.9 +/- 21.8, P = 0.43), and other comorbidities. The mean increase in aortic valve area was 0.39 +/- 0.25 in the BAV alone group and 0.42 +/- 0.26 in the BAV as a bridge group, P = 0.33. The decrease in mean gradient was 24.1 +/- 13.1 in the BAV alone group vs. 27.1 +/- 13.8 in the BAV as a bridge group, P = 0.06. During a median follow up of 183 days [54-409], the mortality rate was 55.2% (n = 214) in the BAV alone group vs. 22.3% (n = 19) in the BAV as a bridge group during a median follow-up of 378 days [177-690], P < 0.001. Conclusion: In high-risk patients with aortic stenosis and temporary contraindications to SAVR/TAVR, BAV may be used as a bridge to intervention with good mid-term outcomes. (c) 2012 Wiley Periodicals, Inc.