How transcatheter aortic valve implantation can revive balloon aortic valvuloplasty

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Until recently, percutaneous balloon aortic valvuloplasty (PBAV) had limited indications as a bridge to surgical aortic valve replacement in elderly patients with depressed left ventricular function. Since the advent of transcatheter aortic valve implantation (TAVI), most high-surgical risk patients are currently referred for TAVI, allowing for a new role for PBAV in three subsets of patients who cannot perform TAVI as first-line treatment: presence of hemodynamic instability – PBAV may improve the clinical status and allow to perform TAVI; presence of a low-flow low-gradient aortic stenosis – PBAV may reveal who benefits from a stable decrease in aortic gradient; and need for major noncardiac surgery – PBAV may reduce the operative risk and allow subsequent definition of the indication to TAVI.

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