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Original research
Clinical outcomes following balloon aortic valvuloplasty
  1. Anda Bularga1,
  2. Rong Bing1,2,
  3. Anoop SV Shah1,2,
  4. Philip D Adamson1,3,
  5. Miles Behan2,
  6. David E Newby1,2,
  7. Andrew Flapan2,
  8. Neal Uren2 and
  9. Nick Cruden2
  1. 1Centre for Cardiovascular Science, University of Edinburgh Division of Health Sciences, Edinburgh, UK
  2. 2Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
  3. 3Christchurch Heart Institute, University of Otago, Dunedin, New Zealand
  1. Correspondence to Dr Anda Bularga; anda.bularga{at}ed.ac.uk

Abstract

Background 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.

Methods 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.

Results 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).

Conclusion 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.

  • aortic valve disease
  • valvuloplasty
  • percutaneous valve therapy
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Footnotes

  • Contributors AB was responsible for data collection, participated in data analysis, data interpretation and drafted the manuscript. RB was responsible for the conceptualisation of the work, data analysis and interpretation and review of the manuscript. ASVS and PDA contributed to the data analysis and interpretation. PDA, DEN, MB, AF, NU contributed to the critical revision of the manuscript. NC was responsible for the conceptualisation of the work and the final review of the manuscript.

  • Funding This work has been supported by the British Heart Foundation (SS/CH/09/002/26360 to AB, PG/19/40/34422 to DEN) and the National Heart Foundation of New Zealand (1844 to PDA).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This work represents a retrospective analysis of clinical data for a cohort of patients who underwent balloon aortic valvuloplasty at the Royal Infirmary of Edinburgh. All data analysed were collected retrospectively as part of routine diagnosis and treatment. This paper does not report on primary research and HRA or NHS REC approvals were not required. The work was conducted following the Caldicott Principles and local approval was obtained.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplemental information.

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