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Standalone balloon aortic valvuloplasty: Indications and outcomes from the UK in the transcatheter valve era
Author(s) -
Khawaja Muhammed Z.,
Sohal Manav,
Valli Haseeb,
Dworakowski Rafal,
Pettit Stephen J.,
Roy David,
Newton James,
Schneider Heiko,
Manoharan Ganesh,
Doshi Sagar,
Muir Douglas,
Roberts David,
Nolan James,
Gunning Mark,
Densem Cameron,
Spence Mark S.,
Chowdhary Saqib,
Mahadevan Vaikom S.,
Brecker Stephen J.,
MacCarthy Philip,
Mullen Michael,
Stables Rodney H.,
Prendergast Bernard D.,
Belder Adam,
Thomas Martyn,
Redwood Simon,
HildickSmith David
Publication year - 2013
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.24534
Subject(s) - medicine , aortic valvuloplasty , cardiology , stenosis , hazard ratio , aortic valve stenosis , balloon , aortic valve , euroscore , cardiac tamponade , percutaneous coronary intervention , tamponade , surgery , artery , myocardial infarction , confidence interval
Objectives We sought to characterize UK‐wide balloon aortic valvuloplasty (BAV) experience in the TAVI era. Background BAV for acquired calcific aortic stenosis is in a phase of renaissance, largely due to the development of transcatheter aortic valve implantation (TAVI). Methods Data from 423 patients at 14 centers across the UK were analyzed. Results Patients were aged 80.9 ± 9.5 years; 52.5% were male. Mean logistic EuroScore was 27.3% ± 16.8%. Mean peak transaortic gradient fell from 62.0 ± 26.3 to 28.3 ± 16.2 mm Hg. Aortic valve area increased from 0.58 ± 0.19 to 0.80 ± 0.25 cm 2 echocardiographically. Procedural complication rate was 6.3%, comprising death (2.4%), blood transfusion ≥2 U (1.2%), cardiac tamponade (1.0%), stroke (1.0%), vascular surgical repair (1.0%), coronary embolism (0.5%), and permanent pacemaker (0.2%). Mortality was 13.8% at 30 days and 36.3% at 12 months. Subsequently, 18.3% of patients underwent TAVI and 7.0% sAVR, with improved survival compared to those who had no further intervention (logrank < 0.0001). Multivariate Cox proportional hazard analysis demonstrated that survival was adversely effected by the presence of coronary artery disease (HR 1.53, 95%CI 1.08–2.17, P = 0.018), poor LV function (HR 1.54, 95%CI 1.09–2.16, P = 0.014), and either urgent (HR 1.70, 95%CI 1.18–2.45; P = 0.004) or emergent presentation (HR 3.72, 95%CI 2.27–6.08; P < 0.0001). Conclusion Balloon aortic valvuloplasty offers good immediate hemodynamic efficacy at an acceptable risk of major complications. Medium‐term prognosis is poor in the absence of definitive therapy. © 2013 Wiley Periodicals, Inc.