1
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Samaja GA. Balloon Aortic Valvuloplasty in the Transcatheter Aortic Valve Implantation Era. Heart Int 2023; 17:13-18. [PMID: 37456354 PMCID: PMC10339465 DOI: 10.17925/hi.2023.17.1.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/24/2023] [Indexed: 07/18/2023] Open
Abstract
As the population continues to grow, and life expectancy has increased, aortic stenosis (AS) has become the most common valvular disease requiring surgical treatment. The evolution of valve replacement therapies has progressed significantly since 1960. In the last 20 years, transcatheter aortic valve implantation (TAVI) has been a game changer, and has potential to become the standard of care. Despite uncertain prognosis benefits, balloon aortic valvuloplasty (BAV) can be useful in a broad range of patients with AS, as well as being a bridging therapy to valve replacement, or as a destination therapy, besides its role in TAVI procedures. This review describes the contemporary role of BAV in AS treatment, and focuses on technical improvements that reframe BAV as an effective tool in a variety of clinical scenarios. One of these improvements is transradial BAV, either with the conventional approach of BAV or applying the bilateral technique with two balloons.
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Affiliation(s)
- Gustavo Arturo Samaja
- Interventional Cardiology Department, Policlinico Bancario Buenos Aires, Buenos Aires, Argentina
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2
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Yuzawa-Tsukada N, Kashiwagi Y, Nonoue A, Uno G, Fujii S, Murakami A, Ogawa K, Kawai M, Muto M, Yoshimura M, Miyamoto T. The safety and feasibility of retrograde balloon aortic valvuloplasty using the INOUE-BALLOON with severe aortic stenosis. Heart Vessels 2022; 37:2093-2100. [PMID: 35842560 DOI: 10.1007/s00380-022-02120-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 06/15/2022] [Indexed: 11/04/2022]
Abstract
In the transcatheter aortic valve implantation (TAVI) era, the indications for balloon aortic valvuloplasty (BAV) are increasing. Previously, the INOUE-BALLOON® (IB) was used only for antegrade BAV, but recently, it has also been used for retrograde BAV. However, the safety and feasibility of retrograde BAV using an IB are not fully understood. In this study, we investigated the safety and feasibility of retrograde BAV using an IB in elderly Japanese patients with severe aortic stenosis (AS). We compared 39 cases of retrograde BAV using an IB performed from June 2018 to September 2020 and 34 cases of antegrade BAV using an IB performed from August 2013 to May 2018. The total number of complications was lower in retrograde BAV than in antegrade BAV (p = 0.020). The procedure time was significantly shorter in retrograde BAV than in antegrade BAV (p < 0.001), and the maximum balloon size and number of balloon inflations were smaller in retrograde BAV than in antegrade BAV (p = 0.002 and p < 0.001, respectively). There was no significant difference in the degree of improvement in the aortic valve area or ejection fraction between retrograde and antegrade BAV. In conclusion, the present study showed the safety and feasibility of retrograde BAV using an IB in elderly Japanese patients with severe AS compared with antegrade BAV using an IB.
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Affiliation(s)
- Naoko Yuzawa-Tsukada
- Division of Cardiology, Department of Internal Medicine, The Jikei University Katsushika Medical Center, 6-41-2 Aoto, Katsushika-ku, Tokyo, 125-8506, Japan. .,Division of Cardiology, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan.
| | - Yusuke Kashiwagi
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Akira Nonoue
- Division of Cardiology, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan.,Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Goki Uno
- Division of Cardiology, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan.,Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinya Fujii
- Division of Cardiology, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan.,Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Akimichi Murakami
- Division of Cardiology, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan
| | - Kazuo Ogawa
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Makoto Kawai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Makoto Muto
- Division of Cardiology, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan.,Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Miyamoto
- Division of Cardiology, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan
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3
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Kleczynski P, Kulbat A, Brzychczy P, Dziewierz A, Trebacz J, Stapor M, Sorysz D, Rzeszutko L, Bartus S, Dudek D, Legutko J. Balloon Aortic Valvuloplasty for Severe Aortic Stenosis as Rescue or Bridge Therapy. J Clin Med 2021; 10:4657. [PMID: 34682783 PMCID: PMC8538854 DOI: 10.3390/jcm10204657] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/07/2021] [Accepted: 10/09/2021] [Indexed: 12/13/2022] Open
Abstract
The study aimed to assess procedural complications, patient flow and clinical outcomes after balloon aortic valvuloplasty (BAV) as rescue or bridge therapy, based on data from our registry. A total of 382 BAVs in 374 patients was performed. The main primary indication for BAV was a bridge for TAVI (n = 185, 49.4%). Other indications included a bridge for AVR (n = 26, 6.9%) and rescue procedure in hemodynamically unstable patients (n = 139, 37.2%). The mortality rate at 30 days, 6 and 12 months was 10.4%, 21.6%, 28.3%, respectively. In rescue patients, the death rate raised to 66.9% at 12 months. A significant improvement in symptoms was confirmed after BAV, after 30 days, 6 months, and in survivors after 1 year (p < 0.05 for all). Independent predictors of 12-month mortality were baseline STS score [HR (95% CI) 1.42 (1.34 to 2.88), p < 0.0001], baseline LVEF <20% [HR (95% CI) 1.89 (1.55-2.83), p < 0.0001] and LVEF <30% at 1 month [HR (95% CI) 1.97 (1.62-3.67), p < 0.0001] adjusted for age/gender. In everyday clinical practice in the TAVI era, there are still clinical indications to BAV a standalone procedure as a bridge to surgery, TAVI or for urgent high risk non-cardiac surgical procedures. Patients may improve clinically after BAV with LV function recovery, allowing to perform final therapy, within limited time window, for severe AS which ameliorates long-term outcomes. On the other hand, in patients for whom an isolated BAV becomes a destination therapy, prognosis is extremely poor.
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Affiliation(s)
- Pawel Kleczynski
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80 Street, 31-202 Krakow, Poland; (J.T.); (M.S.); (J.L.)
| | - Aleksandra Kulbat
- Students’ Scientific Group at the Department of Interventional Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80 Street, 31-202 Krakow, Poland; (A.K.); (P.B.)
| | - Piotr Brzychczy
- Students’ Scientific Group at the Department of Interventional Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80 Street, 31-202 Krakow, Poland; (A.K.); (P.B.)
| | - Artur Dziewierz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (D.S.); (L.R.); (S.B.); (D.D.)
| | - Jaroslaw Trebacz
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80 Street, 31-202 Krakow, Poland; (J.T.); (M.S.); (J.L.)
| | - Maciej Stapor
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80 Street, 31-202 Krakow, Poland; (J.T.); (M.S.); (J.L.)
| | - Danuta Sorysz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (D.S.); (L.R.); (S.B.); (D.D.)
| | - Lukasz Rzeszutko
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (D.S.); (L.R.); (S.B.); (D.D.)
| | - Stanislaw Bartus
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (D.S.); (L.R.); (S.B.); (D.D.)
| | - Dariusz Dudek
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (D.S.); (L.R.); (S.B.); (D.D.)
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80 Street, 31-202 Krakow, Poland; (J.T.); (M.S.); (J.L.)
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Dawson L, Huang A, Selkrig L, Shaw JA, Stub D, Walton A, Duffy SJ. Utility of balloon aortic valvuloplasty in the transcatheter aortic valve implantation era. Open Heart 2020; 7:openhrt-2019-001208. [PMID: 32341170 PMCID: PMC7204556 DOI: 10.1136/openhrt-2019-001208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/23/2020] [Accepted: 02/10/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Balloon aortic valvuloplasty (BAV) has seen renewed interest since the advent of transcatheter aortic valve implantation (TAVI). The study aimed to characterise a contemporary BAV cohort and determinants of clinical outcomes. METHODS Patients undergoing BAV at a single tertiary centre were retrospectively reviewed over a 10-year period, and functional and mortality outcomes were reported with up to a 2-year follow-up. RESULTS 224 patients (aged 82.5±8.3 years; 48% female) underwent BAV over the study period. Indications were either destination treatment (39%) or bridge-to-valve replacement (61%)-including bridge-to-decision (29%), symptom relief while on the waitlist (27%), and temporary contraindications to TAVI/aortic valve replacement (AVR) (5%). The mean reduction of aortic mean pressure gradient was 38%. Procedural mortality occurred in 0.5%, stroke in 1.3%, and major bleeding in 0.9%. Twelve-month mortality was 36% overall, and 26% and 50% in the bridging and destination groups, respectively. New York HeartAssociation (NYHA) class improved by ≥1 at 30 days in 50%. Among the bridge-to-TAVI/AVR group, 40% proceeded to TAVI/AVR within 12 months following BAV. In multivariate analysis, active malignancy at baseline (OR: 4.4, 95% CI: 1.3 to 15.1, p=0.02), smoking history (OR: 3.3, 95% CI: 1.3 to 7.9, p<0.01), LVEF ≤30% at baseline (OR: 3.2, 95% CI: 1.3 to 7.6, p<0.01), destination treatment (OR: 2.2, 95% CI: 1.0 to 4.9, p=0.04) were all associated with 12-month mortality. CONCLUSIONS BAV remains a useful procedure with relatively low rates of complications, however, 1-year mortality rates are high. Contemporary indications for BAV include a bridge to definitive valve replacement or destination treatment.
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Affiliation(s)
- Luke Dawson
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Alex Huang
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Laura Selkrig
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - James A Shaw
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Dion Stub
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Antony Walton
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Stephen J Duffy
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia .,Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
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5
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Kawsara A, Alqahtani F, Eleid MF, El-Sabbagh A, Alkhouli M. Balloon Aortic Valvuloplasty as a Bridge to Aortic Valve Replacement. JACC Cardiovasc Interv 2020; 13:583-591. [DOI: 10.1016/j.jcin.2019.11.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/21/2019] [Accepted: 11/12/2019] [Indexed: 11/15/2022]
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6
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Tabachnick D, Obokhae B, Harrington K, Brown DL. Assessing the risk of an anomalous circumflex artery using balloon aortic valvuloplasty prior to transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2020; 96:497-499. [DOI: 10.1002/ccd.28695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 10/25/2019] [Accepted: 12/20/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Deborah Tabachnick
- Department of Cardiothoracic Surgery The Heart Hospital Baylor Plano Plano Texas
| | - Brigette Obokhae
- Baylor Scott & White Research Institute The Heart Hospital Baylor Plano Plano Texas
| | - Katherine Harrington
- Department of Cardiothoracic Surgery The Heart Hospital Baylor Plano Plano Texas
| | - David L. Brown
- Department of Cardiology The Heart Hospital Baylor Plano Plano Texas
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7
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Sex-Specific Predictors of Mortality Following Balloon Aortic Valvuloplasty. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:945-948. [DOI: 10.1016/j.carrev.2019.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/16/2018] [Accepted: 01/02/2019] [Indexed: 11/20/2022]
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8
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Jones DR, Chew DP, Horsfall MJ, Chuang AM, Sinhal AR, Joseph MX, Baker RA, Bennetts JS, Selvanayagam JB, Lehman SJ. Effect of Balloon Aortic Valvuloplasty on Mortality in Patients With Severe Aortic Stenosis Prior to Conservative Treatment and Surgical or Transcatheter Aortic Valve Replacement. Heart Lung Circ 2019; 29:719-728. [PMID: 31285152 DOI: 10.1016/j.hlc.2019.06.717] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Outcomes following an initial strategy of balloon aortic valvuloplasty (BAV) prior to medical therapy or intervention with surgical or transcatheter aortic valve replacement (SAVR or TAVR) are unclear in the modern transcatheter intervention era. METHODS A retrospective, observational cohort study of the echocardiography, cardiothoracic surgery and TAVR databases between 1 January 2006 and 31 December 2016 was performed to compare outcomes between all patients with severe aortic stenosis (AS) treated with or without BAV prior to medical or invasive therapy. RESULTS 3,142 patients were available for analysis. 223 BAV treated patients had lower mortality relative to medically treated patients, particularly early (20.1% v. 7.6% at 6 months, 58.1% v. 52.5% at 5 years). Over 5 years, the adjusted hazard ratio (HR) was 0.62 (95% CI 0.48-0.80, p < 0.001). Compared with 630 patients proceeding directly to intervention, 75 patients receiving BAV experienced a higher mortality (HR = 2.76, 95% CI 2.07-3.66, p < 0.001). No subsequent excess perioperative mortality was observed with BAV compared with those receiving surgery directly (HR = 1.45, 95% CI 0.91-2.31, p = 0.117). CONCLUSIONS The risk associated with BAV is low, and improves mortality compared with medical therapy. Balloon aortic valvuloplasty treated patients have poorer outcomes, but treatment with BAV does not increase perioperative mortality and may lessen it.
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Affiliation(s)
- Dylan R Jones
- Flinders University, Adelaide, SA, Australia; Flinders Medical Centre, Adelaide, SA, Australia.
| | - Derek P Chew
- Flinders University, Adelaide, SA, Australia; Flinders Medical Centre, Adelaide, SA, Australia
| | | | - Anthony M Chuang
- Flinders University, Adelaide, SA, Australia; Flinders Medical Centre, Adelaide, SA, Australia
| | | | | | - Robert A Baker
- Flinders University, Adelaide, SA, Australia; Flinders Medical Centre, Adelaide, SA, Australia
| | - Jayme S Bennetts
- Flinders University, Adelaide, SA, Australia; Flinders Medical Centre, Adelaide, SA, Australia
| | - Joseph B Selvanayagam
- Flinders University, Adelaide, SA, Australia; Flinders Medical Centre, Adelaide, SA, Australia
| | - Sam J Lehman
- Flinders University, Adelaide, SA, Australia; Flinders Medical Centre, Adelaide, SA, Australia
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9
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Daniec M, Nawrotek B, Sorysz D, Rakowski T, Dziewierz A, Rzeszutko Ł, Kleczyński P, Trębacz J, Tomala M, Żmudka K, Dudek D. Acute and long-term outcomes of percutaneous balloon aortic valvuloplasty for the treatment of severe aortic stenosis. Catheter Cardiovasc Interv 2017; 90:303-310. [PMID: 27514931 DOI: 10.1002/ccd.26697] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 07/03/2016] [Accepted: 07/11/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVES This study aimed to evaluate the indications, short- and long-term outcomes of balloon aortic valvuloplasty (BAV) in patients with severe aortic stenosis (AS). METHODS A cohort of 112 patients with AS underwent 114 BAV procedures between October 2012 and July 2015 in two Polish interventional cardiology centers. Clinical and echocardiographic data were prospectively collected within 1, 6, and 12 months follow-up. RESULTS BAV was performed as a bridge to TAVI (51.8%), surgical aortic valve replacement (AVR, 5.4%), before urgent noncardiac surgery (8.0%), for symptom relief (33.0%) and cardiogenic shock (1.8%). Periprocedural, in-hospital, 1-, 6-, 12-month mortality were 2.7%; 8.9%; 8.9%; 16.9%; 22.3%, respectively. Serious periprocedural adverse events occurred in 18.8% of patients. After the procedure, mean aortic valve area (AVA) increased from 0.59 ± 0.18 to 0.82 ± 0.24 cm2 , mean peak aortic valve gradient (pAVG) decreased from 94.0 ± 27.6 to 65.4 ± 20.0 mm Hg, mean aortic gradient decreased from 58.0 ± 17.8 to 40.5 ± 14.6 mm Hg, P < 0.05 for all. Left ventricular ejection fraction (LVEF) increased from median (interquartile range) of 53.5 (30 - 64) to 60 (45 - 65)% after 1 month (P < 0.05). In patients with impaired left ventricle function (LVEF <40%), LVEF significantly improved (median increase of 16%) after 1 and 6 months (P < 0.05). At 12 months patients had higher AVA, pAVG, and LVEF as compared to baseline (P < 0.05). CONCLUSIONS BAV is a useful procedure in high-risk AS patients, where achieved effects can be sufficient in bridging patients for TAVI/AVR. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Marzena Daniec
- Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Krakow, Poland
| | - Bartłomiej Nawrotek
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, the John Paul II Hospital, Krakow, Poland
| | - Danuta Sorysz
- Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Krakow, Poland
| | - Tomasz Rakowski
- Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Krakow, Poland
| | - Artur Dziewierz
- Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Krakow, Poland
| | - Łukasz Rzeszutko
- Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Krakow, Poland
| | - Paweł Kleczyński
- Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Krakow, Poland
| | - Jarosław Trębacz
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, the John Paul II Hospital, Krakow, Poland
| | - Marek Tomala
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, the John Paul II Hospital, Krakow, Poland
| | - Krzysztof Żmudka
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, the John Paul II Hospital, Krakow, Poland
| | - Dariusz Dudek
- Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Krakow, Poland.,Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, the John Paul II Hospital, Krakow, Poland
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10
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Ford TJ, Nguyen K, Brassil J, Kushwaha V, Friedman D, Allan R, Pitney M, Jepson N. Balloon Aortic Valvuloplasty in the Transcatheter Valve Era: Single Centre Indications and Early Safety Data in a High Risk Population. Heart Lung Circ 2017; 27:595-600. [PMID: 28688833 DOI: 10.1016/j.hlc.2017.05.128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/20/2017] [Accepted: 05/09/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The introduction of transcatheter aortic valve implantation (TAVI) has generated a renewed interest in the techniques available to treat high-risk patients with severe aortic stenosis (AS). We report our single centre experience with balloon aortic valvuloplasty (BAV) focussing on indications, procedural success and 30-day outcomes. METHODS We retrospectively reviewed all patients that underwent BAV procedures at our institution between August 2012 and August 2014. Procedural success and complications were adjudicated according to VARC-2 criteria. RESULTS Fifty-one consecutive adult patients with severe symptomatic AS underwent a total of 55 BAV procedures. The patients had a mean age of 88±5.7 years and all had extensive comorbidities with a high surgical risk (mean logistic EuroSCORE of 25.22%±14.5%). Indications for BAV included palliation of symptoms n=42 (76%); bridge to definitive valve replacement (n=6, 11%); and evaluation of response (n=6, 11%). The procedure was completed in all patients with no intraprocedural deaths (within 24hours) and low 30-day mortality at 3.9% (n=2). Minor vascular complications occurred in 11.8% (n=6), whilst permanent pacemaker implantation was required in 5.8% (n=3). There were no cases of myocardial infarction, stroke, tamponade, severe aortic regurgitation or major vascular complications during 30-day follow-up. CONCLUSIONS Balloon aortic valvuloplasty may be performed safely and effectively with high procedural success and low 30-day complications, even in a very high-risk and elderly cohort of patients in whom the role of TAVI is uncertain or inappropriate.
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Affiliation(s)
- Thomas J Ford
- Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Katherine Nguyen
- Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Joseph Brassil
- Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Virag Kushwaha
- Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Daniel Friedman
- Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Roger Allan
- Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Mark Pitney
- Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Nigel Jepson
- Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia.
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11
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Bongiovanni D, Kühl C, Bleiziffer S, Stecher L, Poch F, Greif M, Mehilli J, Massberg S, Frey N, Lange R, Laugwitz KL, Schymik G, Frank D, Kupatt C. Emergency treatment of decompensated aortic stenosis. Heart 2017; 104:23-29. [PMID: 28566471 DOI: 10.1136/heartjnl-2016-311037] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 04/24/2017] [Accepted: 04/25/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The optimal treatment of patients with acute and severe decompensation of aortic stenosis is unclear due to recent advances in transcatheter interventions and supportive therapies. Our aim was to assess the early outcome of emergency transcatheter aortic valve implantation (eTAVI) versus emergency balloon aortic valvuloplasty (eBAV) followed by TAVI under elective circumstances. METHODS Emergency conditions were defined as: cardiogenic shock with requirement of catecholamine therapy, severe acute dyspnoea (NYHA IV), cardiac resuscitation or mechanic respiratory support. The data were collected according to the Valve Academic Research Consortium 2 (VARC-2) criteria. RESULTS In five German centres, 23 patients (logistic Euroscore 37.7%±18.1) underwent eTAVI and 118 patients underwent eBAV (logistic Euroscore 35.3%±20.8). In the eTAVI group, immediate procedural mortality was 8.7%, compared with 20.3% for the eBAV group (p=0.19). After 30 days, cardiovascular mortality for the eTAVI group was 23.8% and for the eBAV group 33.0% (p=0.40). Analyses adjusting for potential confounders did not provide evidence of a difference between groups. Of note, the elective TAVI performed after eBAV (n=32, logistic Euroscore 25.9%±13.9) displayed an immediate procedural mortality of 9.4% and a cardiovascular mortality after 30 days of 15.6%. Major vascular complications were significantly more likely to occur after eTAVI (p=0.01) as well as stroke (p=0.01). CONCLUSION In this multicentre cohort, immediate procedural and 30-day mortality of eTAVI and eBAV were high, and mortality of secondary TAVI subsequent to eBAV was higher than expected. Randomised study data are required to define the role of emergency TAVI in tertiary care centres with current device generations.
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Affiliation(s)
- Dario Bongiovanni
- I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Constantin Kühl
- Klinik für Innere Medizin III, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Sabine Bleiziffer
- Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Lynne Stecher
- Institut für Medizinische Statistik und Epidemiologie, Technical University of Munich, Munich, Germany
| | - Felix Poch
- I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Martin Greif
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, LMU University, Munich, Germany
| | - Julinda Mehilli
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, LMU University, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, LMU University, Munich, Germany
| | - Norbert Frey
- Klinik für Innere Medizin III, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Rüdiger Lange
- Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Karl-Ludwig Laugwitz
- I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Gerhard Schymik
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Derk Frank
- Klinik für Innere Medizin III, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Christian Kupatt
- I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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12
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Alkhouli M, Zack CJ, Sarraf M, Bashir R, Nishimura RA, Eleid MF, Nkomo VT, Sandhu GS, Gulati R, Greason KL, Holmes DR, Rihal CS. Morbidity and Mortality Associated With Balloon Aortic Valvuloplasty. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004481. [DOI: 10.1161/circinterventions.116.004481] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 03/15/2017] [Indexed: 11/16/2022]
Abstract
Background—
The introduction of transcatheter aortic valve replacement (TAVR) led to renewed interest in balloon aortic valvuloplasty (BAV). We sought to assess contemporary trends in BAV utilization and their outcomes.
Methods and Results—
The Nationwide Inpatient Sample was used to identify patients who underwent BAV between 2004 and 2013. In-hospital morbidity and mortality, and predictors of death after BAV were assessed. Outcomes of propensity-matched groups of patients undergoing elective BAV or TAVR were evaluated. BAV utilization increased from 707 cases in 2004 to 3715 cases in 2013 (national estimates). Procedural and in-hospital mortality were 1.4% and 8.5%, respectively. Vascular complications occurred in 7.0% of cases, blood transfusion in 17.5%, clinical stroke in 1.8%, and pacemaker implantation in 3.0%. The strongest predictors of in-hospital death were cardiogenic shock (odds ratio, 6.01; 95% confidence interval, 4.19–8.61;
P
<0.001), need for left ventricular assist device (odds ratio, 3.48; 95% confidence interval, 2.25–5.36;
P
<0.001), coagulopathy (odds ratio, 2.19; 95% confidence interval, 1.51–3.18;
P
<0.001), and low institutional volume of BAV (odds ratio, 1.58; 95% confidence interval, 1.06–2.37;
P
=0.03). In propensity-matched patients undergoing elective BAV or TAVR, rates of in-hospital mortality (2.9% versus 3.5%;
P
=0.60), clinical stroke (1.6% versus 3.1%;
P
=0.10), and vascular complications (8.2% versus 10.9%;
P
=0.14) were similar. However, BAV was associated with lower rates of pacemaker implantation (2.9% versus 8.0%;
P
<0.001) and blood transfusion (12.8% versus 22.9%;
P
<0.001).
Conclusions—
In a contemporary national registry, BAV is associated with significant morbidity and mortality that are similar to TAVR. With the substantial increase in BAV utilization and the continuous improvement in TAVR outcomes, these data have important implications to aid clinicians in the selection of appropriate BAV candidates.
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Affiliation(s)
- Mohamad Alkhouli
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Chad J. Zack
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Mohammad Sarraf
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Riyaz Bashir
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Rick A. Nishimura
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Mackram F. Eleid
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Vuyisile T. Nkomo
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Gurpreet S. Sandhu
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Rajiv Gulati
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Kevin L. Greason
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - David R. Holmes
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Charanjit S. Rihal
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
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13
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Sakata Y. Transvenous Inoue balloon aortic valvuloplasty with intra-aortic balloon pump in treating cardiogenic shock due to critical calcific aortic stenosis. Cardiovasc Interv Ther 2017; 32:430-435. [PMID: 28044253 DOI: 10.1007/s12928-016-0453-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 12/26/2016] [Indexed: 11/26/2022]
Abstract
A 90-year-old female with severe peripheral vascular disease developed cardiogenic shock (CS) due to critical aortic stenosis (AS). The balloon aortic valvuloplasty was emergently performed via transvenous and transseptal antegrade approach (ante-BAV), which saved arterial accesses for intra-aortic balloon pump (IABP) and enabled us to use the Inoue balloon. The IABP augmented systemic perfusions and controlled left heart filling pressures. Multiple times of inflations with stepwisely increased balloon diameters were performed under IABP support (ante-Inoue-BAV + IABP), resulting in remarkable improvements both in clinical and hemodynamic conditions. The ante-Inoue-BAV + IABP efficaciously and safely treats elderly CS-AS for an emergent hemodynamic stabilization.
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Affiliation(s)
- Yoshihito Sakata
- Division of Cardiology, Ikegami General Hospital, Ikegami 6-1-19, Ota, Tokyo, 146-0082, Japan.
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14
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Mentias A, Faza NN, Raza MQ, Malik A, Devgun J, Rodriguez LL, Mick S, Navia JL, Roselli EE, Schoenhagen P, Svensson LG, Tuzcu EM, Krishnaswamy A, Kapadia SR. Management of Symptomatic Severe Aortic Stenosis in Patient With Very Severe Chronic Obstructive Pulmonary Disease. Semin Thorac Cardiovasc Surg 2016; 28:783-790. [DOI: 10.1053/j.semtcvs.2016.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2016] [Indexed: 11/11/2022]
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15
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Indications and Utility of Percutaneous Balloon Aortic Valvuloplasty in Older Adults. CURRENT GERIATRICS REPORTS 2015. [DOI: 10.1007/s13670-015-0144-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Kamperidis V, Hadjimiltiades S, Mouratoglou S, Ziakas A, Sianos G, Sarafidou A, Ventoulis I, Kazinakis G, Giannakoulas G, Efthimiadis G, Parcharidis G, Karvounis H. Aortic balloon valvuloplasty before transcatheter valve replacement in high-risk patients with aortic stenosis. Herz 2015; 41:144-50. [DOI: 10.1007/s00059-015-4353-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/27/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022]
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17
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Nwaejike N, Mills K, Stables R, Field M. Balloon aortic valvuloplasty as a bridge to aortic valve surgery for severe aortic stenosis. Interact Cardiovasc Thorac Surg 2014; 20:429-35. [DOI: 10.1093/icvts/ivu398] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Pre-dilatation of severely stenotic aortic valves using angioplasty balloons prior to balloon aortic valvuloplasty. Catheter Cardiovasc Interv 2014. [DOI: 10.1002/ccd.25253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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19
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Petronio AS, Giannini C, De Caro F, De Carlo M. How transcatheter aortic valve implantation can revive balloon aortic valvuloplasty. Interv Cardiol 2014. [DOI: 10.2217/ica.14.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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20
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Altarabsheh SE, Greason KL, Schaff HV, Suri RM, Li Z, Mathew V, Joyce LD, Park SJ, Dearani JA. Staged balloon aortic valvuloplasty before standard aortic valve replacement in selected patients with severe aortic valve stenosis. Tex Heart Inst J 2014. [PMID: 24808774 DOI: 10.14503/thij-13-3298.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study evaluated preoperative balloon aortic valvuloplasty (BAV) as a technique to decrease aortic valve replacement (AVR) risk in patients who have severe symptomatic aortic valve stenosis with substantial comorbidity. We report the outcomes of 18 high-risk patients who received BAV within 180 days before AVR from November 1993 through December 2011. Their median age was 78 years (range, 51-93 yr), and there were 11 men (61%). The pre-BAV median calculated Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM) was 18.3% (range, 9.4%-50.7%). Preoperative left ventricular ejection fraction measured a median of 0.23 (range, 0.05-0.68), and the median aortic valve area index was 0.4 cm(2)/m(2) (range, 0.2-0.7 cm(2)/m(2)). The median interval from BAV to AVR was 28 days (range, 1-155 d). There were no strokes or deaths after BAV; however, 4 patients (22%) required mechanical circulatory support, 3 (17%) required femoral artery operation, and 1 (6%) developed severe aortic valve regurgitation. After BAV, the median STS PROM fell to 9.1% (range, 2.6%-25.7%) (compared with pre-BAV, P <0.001). Echocardiography before AVR showed that the median left ventricular ejection fraction had improved to 0.35 (range, 0.15-0.66), and the aortic valve area index to 0.5 cm(2)/m(2) (range, 0.3-0.7 cm(2)/m(2)) (compared with pre-BAV, both P <0.05). All patients received AVR. Operative death occurred in 2 patients (11%), and combined operative death and morbidity in 7 patients (39%). Staged BAV substantially reduces the operative risk associated with AVR in selected patients.
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Affiliation(s)
- Salah Eldien Altarabsheh
- Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905
| | - Kevin L Greason
- Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905
| | - Hartzell V Schaff
- Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905
| | - Rakesh M Suri
- Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905
| | - Zhuo Li
- Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905
| | - Verghese Mathew
- Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905
| | - Lyle D Joyce
- Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905
| | - Soon J Park
- Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905
| | - Joseph A Dearani
- Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905
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21
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Altarabsheh SE, Greason KL, Schaff HV, Suri RM, Li Z, Mathew V, Joyce LD, Park SJ, Dearani JA. Staged balloon aortic valvuloplasty before standard aortic valve replacement in selected patients with severe aortic valve stenosis. Tex Heart Inst J 2014; 41:152-8. [PMID: 24808774 DOI: 10.14503/thij-13-3298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study evaluated preoperative balloon aortic valvuloplasty (BAV) as a technique to decrease aortic valve replacement (AVR) risk in patients who have severe symptomatic aortic valve stenosis with substantial comorbidity. We report the outcomes of 18 high-risk patients who received BAV within 180 days before AVR from November 1993 through December 2011. Their median age was 78 years (range, 51-93 yr), and there were 11 men (61%). The pre-BAV median calculated Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM) was 18.3% (range, 9.4%-50.7%). Preoperative left ventricular ejection fraction measured a median of 0.23 (range, 0.05-0.68), and the median aortic valve area index was 0.4 cm(2)/m(2) (range, 0.2-0.7 cm(2)/m(2)). The median interval from BAV to AVR was 28 days (range, 1-155 d). There were no strokes or deaths after BAV; however, 4 patients (22%) required mechanical circulatory support, 3 (17%) required femoral artery operation, and 1 (6%) developed severe aortic valve regurgitation. After BAV, the median STS PROM fell to 9.1% (range, 2.6%-25.7%) (compared with pre-BAV, P <0.001). Echocardiography before AVR showed that the median left ventricular ejection fraction had improved to 0.35 (range, 0.15-0.66), and the aortic valve area index to 0.5 cm(2)/m(2) (range, 0.3-0.7 cm(2)/m(2)) (compared with pre-BAV, both P <0.05). All patients received AVR. Operative death occurred in 2 patients (11%), and combined operative death and morbidity in 7 patients (39%). Staged BAV substantially reduces the operative risk associated with AVR in selected patients.
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Affiliation(s)
- Salah Eldien Altarabsheh
- Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905
| | - Kevin L Greason
- Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905
| | - Hartzell V Schaff
- Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905
| | - Rakesh M Suri
- Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905
| | - Zhuo Li
- Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905
| | - Verghese Mathew
- Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905
| | - Lyle D Joyce
- Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905
| | - Soon J Park
- Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905
| | - Joseph A Dearani
- Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905
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22
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Dvir D, Waksman R, Barbash IM, Kodali SK, Svensson LG, Tuzcu EM, Xu K, Minha S, Alu MC, Szeto WY, Thourani VH, Makkar R, Kapadia S, Satler LF, Webb JG, Leon MB, Pichard AD. Outcomes of Patients With Chronic Lung Disease and Severe Aortic Stenosis Treated With Transcatheter Versus Surgical Aortic Valve Replacement or Standard Therapy. J Am Coll Cardiol 2014; 63:269-79. [DOI: 10.1016/j.jacc.2013.09.024] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 09/08/2013] [Accepted: 09/10/2013] [Indexed: 02/06/2023]
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23
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Krishnaswamy A, Tuzcu EM. Balloon aortic valvuloplasty for the triage of patients with aortic stenosis. Catheter Cardiovasc Interv 2013; 81:364-5. [PMID: 23423929 DOI: 10.1002/ccd.24786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 12/15/2012] [Indexed: 11/11/2022]
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24
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Eles GR, Khalil R, Lasorda D, Spotti J. Balloon aortic valvuloplasty in elderly patients: a review and update. Interv Cardiol 2013. [DOI: 10.2217/ica.13.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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25
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Abstract
Transcatheter aortic valve replacement (TAVR) was approved in the United States in late 2011, providing a critically needed alternative therapy for patients with severe aortic stenosis previously refused surgical aortic valve replacement (SAVR). Over 20,000 TAVR have been performed in patients worldwide since 2002 when Alain Cribier performed the first-in-man TAVR. This paper reviews the data from balloon expandable and self-expanding aortic stent valves as well as data comparing them with traditional surgical aortic valve replacement (SAVR). Complications using criteria established by the Valve Academic Research Consortium (VARC) are reviewed. Future challenges and possibilities are discussed and will make optimizing TAVR an important goal in the years to come.
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Affiliation(s)
- Patrick P Hu
- International Cardiovascular Institute, 8275 S. Eastern Ave. Suite 200-385, Las Vegas, NV 89123, USA
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