Standalone balloon aortic valvuloplasty: Indications and outcomes from the UK in the transcatheter valve era. Issue 2 (19th February 2013)

• Record Type: Journal Article
• Authors: Khawaja, Muhammed Z.; Sohal, Manav; Valli, Haseeb; Dworakowski, Rafal; Pettit, Stephen J.; Roy, David; Newton, James; Schneider, Heiko; Manoharan, Ganesh; Doshi, Sagar; Muir, Douglas; Roberts, David; Nolan, James; Gunning, Mark; Densem, Cameron; Spence, Mark S.; Chowdhary, Saqib; Mahadevan, Vaikom S.; Brecker, Stephen J.; MacCarthy, Philip; Mullen, Michael; Stables, Rodney H.; Prendergast, Bernard D.; de, Adam; Thomas, Martyn; Redwood, Simon; Hildick‐Smith, David
• Is Part Of: Catheterization and cardiovascular interventions. Volume 81:Issue 2(2013:Feb. 01)
• Page Start: 366
• Page End: 373
• Publication Date: 2013-02-19
• Subjects: Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.24534
• Languages: English
• ISSNs: 1522-1946

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ccd24534-sec-0001" sec-type="section"> <title>Objectives</title> <p>We sought to characterize UK‐wide balloon aortic valvuloplasty (BAV) experience in the TAVI era.</p> </sec> <sec id="ccd24534-sec-0002" sec-type="section"> <title>Background</title> <p>BAV for acquired calcific aortic stenosis is in a phase of renaissance, largely due to the development of transcatheter aortic valve implantation (TAVI).</p> </sec> <sec id="ccd24534-sec-0003" sec-type="section"> <title>Methods</title> <p>Data from 423 patients at 14 centers across the UK were analyzed.</p> </sec> <sec id="ccd24534-sec-0004" sec-type="section"> <title>Results</title> <p>Patients were aged 80.9 ± 9.5 years; 52.5% were male. Mean logistic EuroScore was 27.3% ± 16.8%. Mean peak transaortic gradient fell from 62.0 ± 26.3 to 28.3 ± 16.2 mm Hg. Aortic valve area increased from 0.58 ± 0.19 to 0.80 ± 0.25 cm<sup>2</sup> echocardiographically. Procedural complication rate was 6.3%, comprising death (2.4%), blood transfusion ≥2 U (1.2%), cardiac tamponade (1.0%), stroke (1.0%), vascular surgical repair (1.0%), coronary embolism (0.5%), and permanent pacemaker (0.2%). Mortality was 13.8% at 30 days and 36.3% at 12 months. Subsequently, 18.3% of patients underwent TAVI and 7.0% sAVR, with improved survival compared to those who had no further intervention (logrank < 0.0001). Multivariate Cox proportional hazard analysis demonstrated that survival was adversely effected by the presence of coronary artery disease (HR 1.53, 95%CI 1.08–2.17, <italic>P</italic> = 0.018), poor LV function (HR 1.54, 95%CI 1.09–2.16, <italic>P</italic> = 0.014), and either urgent (HR 1.70, 95%CI 1.18–2.45; <italic>P</italic> = 0.004) or emergent presentation (HR 3.72, 95%CI 2.27–6.08; <italic>P</italic> < 0.0001).</p> </sec> <sec id="ccd24534-sec-0005" sec-type="section"> <title>Conclusion</title> <p>Balloon aortic valvuloplasty offers good immediate hemodynamic efficacy at an acceptable risk of major complications. Medium‐term prognosis is poor in the absence of definitive therapy. © 2013 Wiley Periodicals, Inc.</p> </sec> </abstract>