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Contemporary use of balloon aortic valvuloplasty and evaluation of its success in different hemodynamic entities of severe aortic valve stenosis
Author(s) -
Piayda Kerstin,
Wimmer Anna Christina,
Sievert Horst,
Hellhammer Katharina,
Afzal Shazia,
Veulemans Verena,
Jung Christian,
Kelm Malte,
Zeus Tobias
Publication year - 2021
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.28950
Subject(s) - medicine , aortic valvuloplasty , cardiology , cardiogenic shock , stenosis , balloon , hemodynamics , aortic valve replacement , aortic valve , pressure gradient , aortic valve stenosis , myocardial infarction , physics , mechanics
Objectives To evaluate outcome assessment of percutaneous balloon aortic valvuloplasty (BAV) in different flow and gradient patterns of severe aortic stenosis (AS). Background The mean pressure gradient reduction after BAV is an often‐used surrogate parameter to evaluate procedural success. The definition of a successful BAV has not been evaluated in different subgroups of severe AS, which were introduced in the latest guidelines on the management of patients with valvular heart disease. Methods In this observational study, consecutive patients from July 2009 to March 2018 undergoing BAV were divided into normal‐flow high‐gradient (NFHG), low‐flow low‐gradient (LFLG), and paradoxical low‐flow low‐gradient (pLFLG) AS. Baseline characteristics, hemodynamic, and clinical information were collected and compared. Results One‐hundred‐fifty‐six patients were grouped into NFHG (n = 68, 43.5%), LFLG (n = 68, 43.5%), and pLFLG (n = 20, 12.8%) AS. Mean age of the study population was 81 years. Cardiogenic shock or refractory heart failure (46.8%) was the most common underlying reasons for BAV. Spearman correlation revealed that the mean pressure gradient reduction, determined by echocardiography, had a moderate correlation with the increase in the aortic valve area (AVA) in patients with NFHG AS (ρ: 0.529, p < .001) but showed no association in patients with LFLG (ρ: 0.017, p = .289) and pLFLG (ρ: 0.030, p = .889) AS. BAV as bridge to surgical or transcatheter aortic valve replacement was possible in 44.2% of patients, with no difference between groups ( p = .070). Conclusion The mean pressure gradient reduction might be an adequate surrogate parameter for BAV success in patients with NFHG AS but is not suitable for patients with other hemodynamic entities.