Clinical and Echocardiographic Features Associated With Improved Survival in Patients With Severe Aortic Stenosis Undergoing Balloon Aortic Valvuloplasty (BAV)

• Published in: The Journal of invasive cardiology 2020-11, Vol.32 (11), p.E277-E285
• Main Authors: Husaini, Mustafa, Soyama, Yuko, Kagiyama, Nobuyuki, Thakker, Prashanth, Thangam, Manoj, Haque, Nowrin, Deych, Elena, Sintek, Marc, Lasala, John, Gorcsan, 3rd, John, Zajarias, Alan
• Format: Article
• Language: English
• ISSN: 1557-2501

Balloon aortic valvuloplasty (BAV) is used in high-risk patients with severe aortic stenosis (AS) when the benefit of transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) is unclear. Our objective was to identify clinical or echocardiographic features that identify patients likely to benefit from BAV. We studied 141 consecutive patients who underwent BAV from July, 2011 to October, 2017. Clinical characteristics, routine echocardiographic parameters, and speckle tracking imaging of global longitudinal strain (GLS) were assessed before and after BAV. The primary outcome was all-cause mortality as ascertained by the National Death Index. There were 141 patients, median age, 80 years (interquartile range [IQR], 74-87 years) with severe AS (median aortic valve area, 0.66 cm²; IQR, 0.53-0.79 cm²) and median mean gradient of 36 mm Hg (IQR, 27-48 mm Hg) who underwent BAV. The 1-year mortality rate was 52%. Characteristics associated with survival were New York Heart Association class I symptoms, lower brain natriuretic peptide level, higher left ventricular ejection fraction (LVEF) >53%, and higher GLS (>13.2%; absolute values were used for GLS). Landmark analysis at 60 days showed the 47 patients who underwent TAVR/SAVR after BAV had significantly better 1-year survival than those who did not (P