Abstract 14243: Balloon Aortic Valvuloplasty: Insights Into Subsequent Treatments and Long Term Outcome
Introduced in 1986, balloon aortic valvuloplasty (BAV) has gained new interest since the development of trans-catheter aortic valve implantation (TAVI). BAV has become safer but is still associated with high restenosis rate restricting its use to critically ill patients as a bridge to aortic valve replacement (AVR) or before non-cardiac surgery. The aim of our retrospective study was to analyze the long-term outcome after BAV and to identify the predictors of survival.
Methods and results: From 2005 to 2008, 323 patients were treated by BAV using the retrograde trans-femoral approach. Mean age was 80 ± 10 years and mean Euroscore was 18.3±12.6%. Effective orifice area increased from 0.68±0.24 to 1.12±0.39cm2 (p<0.001) after BAV. Early mortality rate (<7days) was 3.4%. Follow-up was obtained in 98% of patients at a mean of 15.8±13 months. Thirty one patients (9.6%) underwent subsequent AVR, 54 (16.7%) had TAVI and 28 (8.7%) had at least one repeat BAV with a delay of 7.3±9.8, 5.9±6.1 and 9.8±8.5 months respectively. Two hundred ten patients (65%) remained on medical treatment alone. At five years, Kaplan-Meier estimated survival after single BAV was poor (5.1%). Repeat BAV improved the outcome (20.9%), however only patients treated by BAV as a bridge to AVR or TAVI had a significantly better survival rate (70.01% and 42.56% respectively; p<0.0001). By univariate analysis, old age, high Euroscore, low systolic and mean aortic pressure, decreased cardiac output, poor left ventricle ejection fraction, medical treatment alone and absence of subsequent AVR or TAVI were predictive of long term mortality; however, only Euroscore (OR: 1.056, 95% CI, 1.02 – 1.09; p=0.001) and absence of subsequent AVR (OR: 0.197, 95% CI, 0.06 – 0.69; p=0.006) or TAVI (OR: 0.165, 95% CI, 0.06 – 0.40; p<0.0001) maintained their significance with multivariate analysis. In conclusion, in high-risk patients, BAV offers a short-term hemodynamic improvement. BAV must ideally be used as a bridge to AVR or TAVI.
- © 2010 by American Heart Association, Inc.