P977Balloon aortic valvuloplasty in severe aortic stenosis and its impact on pulmonary hypertension in elderly

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Purpose of the study: Balloon aortic valvuloplasty (BAV) is considered a palliative treatment option for patients with symptomatic, severe aortic stenosis (AS) and high risk for surgical valve replacement. Pulmonary artery hypertension in AS is common and is associated with increased mortality. We assessed the impact of BAV on pulmonary hypertension in selected high risk patients with AS.Patients and metods: We retrospectively analyzed 51 patients (male 10, female 41; mean age 82 years; mean logistic EuroSCORE 22,7) with symptomatic severe AS that underwent BAV in our institution between May 2009 and January 2011. Inclusion criteria for BAV were severe AS and any of the following: increased perioperative risk, bridge to surgical aortic valve replacement or transarterial aortic valve implantation (TAVI), before urgent major non-cardiac surgery, patients who refused surgery. Description of the procedure: BAV was preformed via transfemoral approach. Balloon inflation (balloon Optimed, 16 to 22 mm x 40 mm) was repeated from 2 to 4 times with a goal to reduce peak to peak transaortic pressure gradient by at least 50%. Echocardiographic examination was performed before BAV and during the follow-up at three months.Results: After a successful BAV we observed a significant increase in AVA (0,61 to 0,72 cm2, p<0,001) accompanied by a fall in peak and mean transvalvular gradients (mean transvalvular gradient: 47 to 38 mmHg, p<0,001) with no influence on LVEF. Patients were divided into two groups based on pulmonary artery systolic pressure (PASP): group I (N=23; 51,1%) with PASP >50 mm Hg and group II (N=22; 48,9%) with PASP < 50 mm Hg. There were no differences in LEVF between the groups. In group I we observed a significant decrease in PASP (67 mmHg to 60 mmHg, p=0,039) and a significant reduction in mitral regurgitation (from 2,8/4 to 2,1/4; p=0,029), in group II the reduction of PASP and MR were not statistically significant (from 41 to 40 mmHg, p=0,840 and 1,9/4 to 1,7/4, p=0,66 respectively). The reduction in PASP persisted at 3 months follow up.Conclusion: Balloon aortic valvuloplasty is an effective treatment for selected high risk patients with severe aortic stenosis and results in a significant decrease in PASP. The reduction in PASP may be associated with unloading of the left ventricle and the reduction of mitral regurgitation that can occur after BAV.

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