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Balloon aortic valvuloplasty--ups and downs--are we facing a procedure comeback?

BACKGROUND
Recently, there has been renewed interest in balloon aortic valvuloplasty (BAV).


AIM
To analyse the indications and short-term outcome of BAV since transcatheter aortic valve implantation (TAVI) was launched in our institution.


METHODS
Between September 2010 and September 2014, 25 consecutive patients (19 female, 6 male) underwent BAV. The mean age was 72 ± 11.4 years, mean EuroScore II was 10.4 ± 11.7%, mean logistic EuroScore 23.5 ± 23.6%, mean Society of Thoracic Surgeons mortality risk score was 21.8 ± 13.6%. The indications for BAV were: advanced haemodynamically unstable heart failure (HF) including cardiogenic shock or pulmonary oedema (n = 7), co-morbidities requiring urgent non-cardiac surgery (n = 8), palliative treatment (n = 6), and an intention to bridge to TAVI or aortic valve replacement in patients with severe HF (n = 4).


RESULTS
In-hospital mortality was 20% (n = 5) and occurred in patients who underwent BAV in the setting of haemodynamically unstable HF. Other major complications included pacemaker implantation (n = 2), major vascular complications (n = 4), and cardiac tamponade (n = 1). There were no patients who required conversion to cardiac surgery. The mean peak aortic transvalvular gradient decreased from 96.9 ± 29.5 to 60.3 ± 15.5 mm Hg (p = 0.0001) after BAV. We did not observe significant aortic regurgitation.


CONCLUSIONS
Treatment of advanced and haemodynamically unstable aortic stenosis, bridge to non-cardiac surgery and palliative therapy are the main reasons for BAV in recent years. BAV as a bridge to TAVI or aortic valve replacement may be an option for some patients. Short-term results are good with relatively low mortality and morbidity related to the procedure. Mortality in haemodynamically unstable patients presenting with cardiogenic shock or pulmonary oedema treated with BAV is very high.