81 Balloon Aortic Valvuloplasty in the Tavr ERA – Single Tertiary Centre Experience

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Abstract

Background

The use of balloon aortic valvuloplasty (BAV) is increasing in the current transcatheter aortic valve replacement (TAVR) era. There are no clear guidelines regarding follow-up or predictors of functional and echocardiographic recovery following BAV, which can affect timing of subsequent intervention. We present our experience of BAV.

Methods

We performed retrospective analysis of patients who underwent BAV for severe aortic stenosis (AS) at our institution, between August 2008 and October 2013. We reviewed population characteristics, indications, periprocedural and follow-up transthoracic echocardiographic data (TTE).

Results

Between August 2008 and October 2013 86 BAV procedures were performed on 78 patients.A single BAV was performed in 72 patients, 6 had >1 procedure. Males 55.1% (n = 43), mean age 82.2 years, all had multiple co-morbidities. Indications for BAV included: i) symptoms palliation (n = 46), including discharge facilitation (n = 7), ii) facilitate non-cardiac surgery (n = 5), iii) assess symptomatic response (in multifactorial breathlessness) and potential bridge to destination therapy (n = 27); no data (n = 8). Patients were divided into 2 groups: group A, LV EF≥40% (n = 56) and group B, LV EF <40% (n = 25). AV area (AVA) improved significantly immediately after BAV (group A pre BAV 0.67cm2 ± 0.22 to 0.91cm2 ± 0.20, p < 0.05; group B 0.61cm2 ± 0.28 to 0.88cm2 ± 0.29, p < 0.05). Mortality over the period was 42.3% (n = 33), with deaths occurring in group A at median time of 9.5 months and in group B at 3.25 months following BAV. 13 patients underwent valve replacement, 4 surgical and 9 TAVR. Follow-up TTE was available in 33; group A, n = 22 (mean follow-up 4.2 months);group B, n = 11 (mean follow-up 2.7 months). Table 1 shows TTE data at baseline and follow-up.

Conclusions

BAV was performed in a high risk elderly population for a number of indications. After BAV, an early improvement in all AS parameters was seen. It appears be a useful screening tool to help determine which patients will benefit from definitive therapy and used to facilitate discharge and palliation. Further data is needed to establish predictors of left ventricular recovery and optimal timing of subsequent interventions.

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