Balloon aortic valvuloplasty in high risk aortic stenosis patients with left ventricular ejection fractions <20%. Issue 5 (8th August 2014)

• Record Type: Journal Article
• Authors: Pedersen, Wes R.; Goldenberg, Irvin F.; Pedersen, Christopher W.; Lesser, Andrew; Harris, Kevin M.; Lesser, John R.; Garberich, Ross F.; Schwartz, Jonathan G.; Shank, Emily; Schwartz, Robert S.
• Is Part Of: Catheterization and cardiovascular interventions. Volume 84:Issue 5(2014:Nov. 01)
• Page Start: 824
• Page End: 831
• Publication Date: 2014-08-08
• Subjects: Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.25328
• Languages: English
• ISSNs: 1522-1946

Abstract

&lt;abstract abstract-type=&quot;main&quot;&gt; &lt;title&gt; &lt;x xml:space=&quot;preserve&quot;&gt;Abstract&lt;/x&gt; &lt;/title&gt; &lt;sec id=&quot;ccd25328-sec-0001&quot; sec-type=&quot;section&quot;&gt; &lt;title&gt;Objectives&lt;/title&gt; &lt;p&gt;To determine outcomes following balloon aortic valvuloplasty (BAV) in aortic stenosis (AS) patients with a left ventricular ejection fraction (LVEF) &amp;lt;20%.&lt;/p&gt; &lt;/sec&gt; &lt;sec id=&quot;ccd25328-sec-0002&quot; sec-type=&quot;section&quot;&gt; &lt;title&gt;Background&lt;/title&gt; &lt;p&gt;Severe AS patients with a LVEF &amp;lt;20% are excluded from United States (U.S.) transcatheter aortic valve replacement (TAVR) trials and often surgical aortic valve replacement (AVR). The role for BAV to enhance LVEF is unclear.&lt;/p&gt; &lt;/sec&gt; &lt;sec id=&quot;ccd25328-sec-0003&quot; sec-type=&quot;section&quot;&gt; &lt;title&gt;Methods&lt;/title&gt; &lt;p&gt;Our BAV database of 270 consecutive patients extending from 2005 through 2010 was queried for a preoperative LVEF &amp;lt;20%. Demographics, echocardiograms, procedural technique, and outcomes were analyzed. Pre‐ and postoperative echocardiograms were used to determine improvement in aortic valve area (AVA) and LVEF.&lt;/p&gt; &lt;/sec&gt; &lt;sec id=&quot;ccd25328-sec-0004&quot; sec-type=&quot;section&quot;&gt; &lt;title&gt;Results&lt;/title&gt; &lt;p&gt;Sixteen patients were identified with a median age of 82 years. The composite Society of Thoracic Surgeons&#39; (STS) mortality risk was 16.4%. The median preoperative AVA and LVEF were 0.60 cm&lt;sup&gt;2&lt;/sup&gt; and 16%, respectively, and postoperative AVA and LVEF were 0.77 cm&lt;sup&gt;2&lt;/sup&gt; and LVEF 19%, respectively. About 15 of the 16 patients had postoperative echocardiograms available for comparison. And 7 of these 15 (47%) demonstrated improvement in LVEF to ≥20% (median LVEF 25%). The absence of coronary disease and improvement in AVA of ≥0.2 cm&lt;sup&gt;2&lt;/sup&gt; was associated with postoperative LVEF of ≥20%. Procedural mortality was 0%. The 30‐day, 6‐month, and 1‐year survival was 69%, 56%, and 29%. STS&#39;s mortality risk score ≥15% was associated with short‐term mortality.&lt;/p&gt; &lt;/sec&gt; &lt;sec id=&quot;ccd25328-sec-0005&quot; sec-type=&quot;section&quot;&gt; &lt;title&gt;Conclusion&lt;/title&gt; &lt;p&gt;With appropriate technique, BAV can be reasonably safe in patients with LVEF &amp;lt;20%. Roughly half of these patients demonstrated improvement in LVEF to ≥20%. © 2013 Wiley Periodicals, Inc.&lt;/p&gt; &lt;/sec&gt; &lt;/abstract&gt;