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Incidence, treatment, and outcome of acute aortic valve regurgitation complicating percutaneous balloon aortic valvuloplasty
Author(s) -
Dall'Ara Gianni,
Saia Francesco,
Moretti Carolina,
Marrozzini Cinzia,
Taglieri Nevio,
Bordoni Barbara,
Chiarabelli Matteo,
Ciuca Cristina,
Rapezzi Claudio,
Marzocchi Antonio
Publication year - 2017
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.26378
Subject(s) - medicine , aortic valvuloplasty , cardiology , regurgitation (circulation) , balloon , percutaneous , aortic valve , incidence (geometry) , surgery , aortic valve stenosis , physics , optics
Objectives To evaluate the incidence, treatment, and outcomes of acute aortic regurgitation (ARR) complicating BAV. Background In the transcatheter aortic valve implantation (TAVI) era, there is an increase of percutaneous balloon aortic valvuloplasty (BAV) procedures with different indications. Methods From the prospective BAV registry of the University of Bologna, which has enrolled patients between the year 2000 and the present, we selected those who suffered intraprocedural AAR with overt hemodynamic instability. Worsening of baseline aortic insufficiency without hemodynamic collapse, treatment of degenerated biological valve prosthesis, and BAV performed within a planned TAVI procedure were excluded. The main endpoints were in‐hospital and 30‐day mortality. Results Out of 1517 BAVs, we identified 26 cases of AAR (1.7%). This complication occurred in 80.8% of cases after one or two balloon inflations. Mean transaortic gradient decreased from 50.6 ± 19.3 to 26.0 ± 14.4 mm Hg ( p < 0.01). In 8(30.8%) patients, AAR spontaneously resolved within few minutes; in 18 cases, the operators had to perform a rescue maneuver to reposition a valve leaflet got stuck in the opening position (this maneuver was successful in 13/18 of the cases, 72.2%). Out of 5 persistent AAR, 3 were managed with emergency TAVI or surgery, while 2 were unresolved. In‐hospital mortality was 15.4% ( n = 4), whereas no more deaths occurred up to 30 days. Conclusions AAR is a fearsome complication of BAV and portends a grim prognosis. In some cases, it can be resolved with appropriate technical maneuvers; in others, a rescue TAVI or surgical valve replacement may be necessary. © 2015 Wiley Periodicals, Inc.