Abstract 3109: Immediate Outcomes and Complications of Percutaneous Aortic Valvuloplasty: Inoue Anterograde Transseptal versus Conventional Retrograde Approach
Introduction: Percutaneous Aortic Valvuloplasty (PAV) is a technique used as compassionate treatment of aortic stenosis. The most common technique for balloon aortic valvuloplasty is retrograde approach (PAV-R), passing the balloon via the femoral artery, using 12–14 Fr sheaths. Anterograde approach (PAV-A), using vein access and interatrial septal puncture, has been proposed as an alternative.
Hypothesis: The aim of the study is to determine whether anterograde transseptal approach could offer similar results with less complication compared to the retrograde approach of PAV.
Methods: Data from all PAV performed in adults at the Massachusetts General Hospital between 2001and 2006 was collected. Severity of aortic stenosis was assessed hemodynamically by determination of the mean systolic gradient and the aortic valve area. All complications including vascular/non-vascular and intrahospital death were obtained. Immediate results and complications in both the groups of PAV were then compared.
Results: A total of one hundred and sixty three patients were included (mean age: 80.4 ± 11.5 years). PAV- A was performed in 52 patients and PAV-R in 111 patients. There were no differences between the two groups, according to demographic characteristics and severity of aortic stenosis. Postprocedure valve area (1.1 ± 0.3 vs. 1.1 ± 0.5) and mean systolic gradient (26 ± 10 vs. 22 ±10 mm Hg) for the PAV-A and PAV-R groups respectively were similar (p=NS). Vascular complications (7% vs. 0%; p<0.05) were significantly higher in retrograde group, with no vascular complications in PAV-A group. Intrahospital events, and other procedure complications were similar. Thirty-day mortality (5% vs. 8%; p=NS) for the PAV-A and the PAV-R groups respectively was also similar.
Conclusions: In conclusion, transseptal anterograde PAV approach using the Inoue balloon results in similar acute hemodynamic results. However, this approach avoids vascular complications that are common in the retrograde approach.