Balloon aortic valvuloplasty in the transcatheter aortic valve implantation era: A single-center registry

• Published in: Revista portuguesa de cardiologia 2017-04, Vol.36 (4), p.251-256
• Main Authors: Francisco, Ana Rita G., Nobre Menezes, Miguel, Carrilho Ferreira, Pedro, Jorge, Cláudia, Silva, Doroteia, Infante de Oliveira, Eduardo, Pinto, Fausto J., Canas da Silva, Pedro
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon; Aortic Valve Stenosis - surgery; Balloon aortic valvuloplasty; Estenose aórtica grave; Female; Heart Failure - surgery; Humans; Implantação valvular aórtica percutânea; Male; Postoperative Complications - epidemiology; Registries; Retrospective Studies; Severe aortic stenosis; Transcatheter aortic valve implantation; Transcatheter Aortic Valve Replacement; Treatment Outcome; Valvuloplastia aórtica por balão
• ISSN: 0870-2551; 2174-2030
• DOI: 10.1016/j.repc.2016.09.016

Percutaneous balloon aortic valvuloplasty (BAV) has been limited by the risk of complications and restenosis. However, growing use of transcatheter aortic valve implantation (TAVI) has revived interest in this technique. We analyzed the current indications for BAV and outcomes in a single center. Acute results and long-term outcomes were analyzed in a retrospective single-center registry of patients undergoing BAV between January 2013 and January 2016. Twenty-three patients underwent BAV, 56.5% male, mean age 78±7 years. Indications were severe aortic stenosis and decompensated heart failure (n=5), urgent non-cardiac surgery (n=8), or bridge to definitive treatment (n=10). Peak invasive gradient decreased from a median of 54.0±19.0 mmHg to 28.5±13.8 mmHg (p=0.002). Complications included one ischemic stroke, one lower limb ischemia and one femoral pseudoaneurysm requiring surgery. During a mean follow-up of 11±10 months, eight patients underwent TAVI and two underwent surgical aortic valve replacement. Thirteen patients died, nine of non-cardiovascular causes. On Kaplan-Meier analysis mortality was significantly lower among patients undergoing definitive treatment (20.0% vs. 84.6% at two-year follow-up; p=0.005). BAV should be considered for selected patients with temporary contraindications to definitive therapy or as palliative therapy. A implantação de próteses aórticas percutâneas reavivou o interesse na valvuloplastia aórtica por balão, habitualmente limitada por complicações e restenose. Analisámos as indicações e resultados desta técnica. Registo retrospetivo, unicêntrico, de doentes submetidos a valvuloplastia aórtica por balão, de janeiro de 2013 a janeiro de 2016. Analisaram-se os resultados imediatos e a longo prazo. Vinte e três doentes foram submetidos a valvuloplastia aórtica por balão, 56,5% homens, idade média 78±7 anos. As indicações foram estenose aórtica grave com: insuficiência cardíaca descompensada (n=5); cirurgia não-cardíaca urgente (n=8); ponte para terapêutica definitiva (n=10). O gradiente de pico invasivo reduziu-se de uma mediana de 54,0 (19,0) mmHg para 28,5 (13,8) mmHg (p=0,002). Registaram-se um acidente vascular cerebral isquémico, uma isquemia aguda do membro inferior e um pseudoaneurisma femoral resolvidos cirurgicamente. Durante um seguimento médio de 11±10 meses, efetuaram-se oito implantações percutâneas de prótese aórtica e duas substituições cirúrgicas. Treze doentes morreram, nove de causas não-cardiovasculares. Por