Conflict of interest: Nothing to report.
Valvular and Structural Heart Diseases
Is balloon aortic valvuloplasty safe in patients with significant aortic valve regurgitation?†
Article first published online: 30 NOV 2011
Copyright © 2011 Wiley Periodicals, Inc.
Catheterization and Cardiovascular Interventions
Volume 79, Issue 2, pages 315–321, 1 February 2012
How to Cite
Saia, F., Marrozzini, C., Ciuca, C., Bordoni, B., Dall'Ara, G., Moretti, C., Taglieri, N., Palmerini, T., Branzi, A. and Marzocchi, A. (2012), Is balloon aortic valvuloplasty safe in patients with significant aortic valve regurgitation?. Cathet. Cardiovasc. Intervent., 79: 315–321. doi: 10.1002/ccd.23092
- Issue published online: 23 JAN 2012
- Article first published online: 30 NOV 2011
- Accepted manuscript online: 26 APR 2011 10:31AM EST
- Manuscript Accepted: 26 FEB 2011
- Manuscript Received: 27 JAN 2011
- aortic valve stenosis;
- aortic regurgitation;
Objectives: To assess safety and effectiveness of balloon aortic valvuloplasty (BAV) in patients with symptomatic severe aortic stenosis (AS) and significant aortic regurgitation.
Background: BAV is a palliative procedure that has possibly been underused in patients with symptomatic AS not suitable for surgical aortic valve replacement or transcatheter aortic valve implantation. Significant aortic regurgitation is commonly perceived as a contraindication to BAV.
Methods: Among 416 consecutive patients undergoing BAV at our Institution, 73 patients showed moderate or severe AR before the procedure. Demographics and baseline characteristics, as well as in-hospital clinical outcome, have been prospectively collected in a dedicated database. Transthoracic echocardiography was regularly performed in all patients undergoing BAV before the procedure and at hospital discharge.
Results: Patients had a high-risk profile, confirmed by advanced age (77.2 ± 11.8 years) and important comorbidity (logistic Euroscore 26.5 ± 16.3%). Advanced heart failure was present in 73.9%. Indication to BAV was cardiogenic shock in 9.6%, palliation in 31.5%, bridge in 58.9% of the patients. BAV was performed with standard retrograde approach. Aortic valve area increased from 0.62 ± 0.15 cm2 at baseline to 0.83 ± 0.17 cm2 before discharge (P < 0.001). The degree of AR was improved or unchanged in 65 patients (89%). In-hospital mortality was 6.9%, mainly limited to terminal patients. Symptomatic status at discharge was improved in all surviving patients. Acute AR occurred in seven patients; in five of them it was successfully resolved in the catheterization laboratory.
Conclusions: When clinically indicated, BAV can be safely performed in patients with combined aortic stenosis and significant aortic regurgitation. © 2011 Wiley Periodicals, Inc.