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Interventional cardiology
Original research
Utility of balloon aortic valvuloplasty in the transcatheter aortic valve implantation era
  1. Luke Dawson1,2,
  2. Alex Huang1,3,
  3. Laura Selkrig1,
  4. James A Shaw1,
  5. Dion Stub1,3,
  6. Antony Walton1 and
  7. Stephen J Duffy1,3
  1. 1Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
  2. 2Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
  3. 3Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
  1. Correspondence to Dr Stephen J Duffy; S.Duffy{at}alfred.org.au

Abstract

Background Balloon aortic valvuloplasty (BAV) has seen renewed interest since the advent of transcatheter aortic valve implantation (TAVI). The study aimed to characterise a contemporary BAV cohort and determinants of clinical outcomes.

Methods Patients undergoing BAV at a single tertiary centre were retrospectively reviewed over a 10-year period, and functional and mortality outcomes were reported with up to a 2-year follow-up.

Results 224 patients (aged 82.5±8.3 years; 48% female) underwent BAV over the study period. Indications were either destination treatment (39%) or bridge-to-valve replacement (61%)—including bridge-to-decision (29%), symptom relief while on the waitlist (27%), and temporary contraindications to TAVI/aortic valve replacement (AVR) (5%). The mean reduction of aortic mean pressure gradient was 38%. Procedural mortality occurred in 0.5%, stroke in 1.3%, and major bleeding in 0.9%. Twelve-month mortality was 36% overall, and 26% and 50% in the bridging and destination groups, respectively. New York HeartAssociation (NYHA) class improved by ≥1 at 30 days in 50%. Among the bridge-to-TAVI/AVR group, 40% proceeded to TAVI/AVR within 12 months following BAV. In multivariate analysis, active malignancy at baseline (OR: 4.4, 95% CI: 1.3 to 15.1, p=0.02), smoking history (OR: 3.3, 95% CI: 1.3 to 7.9, p<0.01), LVEF ≤30% at baseline (OR: 3.2, 95% CI: 1.3 to 7.6, p<0.01), destination treatment (OR: 2.2, 95% CI: 1.0 to 4.9, p=0.04) were all associated with 12-month mortality.

Conclusions BAV remains a useful procedure with relatively low rates of complications, however, 1-year mortality rates are high. Contemporary indications for BAV include a bridge to definitive valve replacement or destination treatment.

  • aortic valve disease
  • valvuloplasty
  • valvular disease
  • quality of care and outcomes
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/openhrt-2019-001208

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    Footnotes

    • Contributors All authors contributed to conception and design of the study. LD: performed the data collection, statistical analysis and initial manuscript drafting. LD and SD: responsible for the overall content. All authors contributed to conception and design of the study; contributed to interpretation of results and critical revision of the manuscript.

    • Funding Professor Duffy's work is funded by National Health and Medical Research Council grants.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. Data are available upon reasonable request.