Abstract 4432: Updated Technique, Indications and Immediate Results of Percutaneous Balloon Aortic Valvuloplasty for Calcific Aortic Stenosis in a Highly Experienced Center
Management of aortic stenosis in elderly patients, especially when associated with complex comorbidities, has become an important issue. For these higher surgical risk patients, the role of percutaneous balloon aortic valvuloplasty (BAV) remains discussed. Overall improvements in techniques and hardware have made the procedure more efficient, fast and safe. We report the updated technique, indications and immediate results of BAV in our highly experienced center.
Methods: From Jan 2007 to Dec 2008, BAV was performed in 213 patients, 47% women, aged 81±10 years. BAV is performed under local anesthesia using the percutaneous retrograde approach. Through a 10F sheath, 20, 23, or 25 mm size balloons (Cristal balloon, BALT) are advanced to the native valve over an extra-stiff wire. Initial balloon size is selected on annulus size, degree of valvular calcification and associated aortic regurgitation. Sequential increase in balloon size is often required. The goal is to increase the effective valve area (EOA) by near 100% and decrease the mean gradient to <25 mmHg. Rapid right ventricular pacing (180 to 220 bpm) is systematically used during balloon inflation. Percutaneous closure of the femoral approach is obtained with an 8F Angioseal.
Results: The indications were as follows: bridge to AVR in severely depressed ventricular function (n=17), urgent BAV before non cardiac surgery (n=15), emergent BAV for cardiogenic shock (n=30), bridge to transcathter valve implantation (n=132), compassionate and other (n=19). EOA (Gorlin’s formula) increased from 0.70±0.26 to 1.15±0.58 cm2 (p<0.001) and mean gradient decreased from 42.3±19.8 to 19.9±11.4 mmHg (p<0.001). Seven patients (3%) died and 17 patients (8%) had non fatal in-hospital complications: 6 strokes or TIA (2.8%), 4 ≥ grade 3 aortic regurgitation (1.9%), 3 complete atrio-ventricular block (1.4%), 1 cardiac tamponade and 3 surgical vascular complications (1.4%). Total hospital stay was 5.5±5.7 days.
Conclusion: BAV has become much simpler and safer in spite of being applied in severely ill patients. This technique remains indicated in various situations, with an emerging indication in highly symptomatic/life threatened patients on the waiting list for transcatheter valve implantation.