title: The role of percutaneous balloon aortic valvuloplasty as a bridge for transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Many inoperable patients with severe aortic stenosis (AS) are not immediately eligible for transcatheter aortic valve implantation (TAVI). We evaluated the role of percutaneous balloon aortic valvuloplasty (BAV) in this setting.
  
  
  RESULTS
  Among 210 consecutive patients referred to our institution for BAV, we identified three groups: immediately eligible for TAVI (n=65, 31%), excluded from TAVI (n=67, 32%), BAV as a bridge to TAVI (n=78, 37%). This last group comprised patients with low left ventricular ejection fraction, frailty or enfeebled status, symptoms of uncertain origin, critical conditions, moderate-to-severe mitral valve regurgitation, need of major non-cardiac surgery. Outpatient clinic visit and echocardiography were performed around one month after BAV to decide the final therapeutic strategy. Mean age was 81±8 years and the vast majority of patients had comorbidities and high-risk features. The incidence of periprocedural adverse events was 6.4%: 5.1% death (four patients: one procedural complication, three, natural disease progression), 1.3% minor stroke. After BAV, 46% of these patients were deemed eligible for TAVI, and 28% for cardiac surgery. Patients who underwent TAVI after bridge BAV showed 94% 30-day survival.
  
  
  CONCLUSIONS
  BAV is a safe and effective tool to bridge selected patients to TAVI when indications are not obvious.
authors: Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy. francescosaia@hotmail.com
authors: Francesco
authors: F
authors: Saia
authors: Cinzia
authors: C
authors: Marrozzini
authors: Carolina
authors: C
authors: Moretti
authors: Cristina
authors: C
authors: Ciuca
authors: Nevio
authors: N
authors: Taglieri
authors: Barbara
authors: B
authors: Bordoni
authors: Gianni
authors: G
authors: Dall'ara
authors: Laura
authors: L
authors: Alessi
authors: Valerio
authors: V
authors: Lanzillotti
authors: Maria Letizia
authors: ML
authors: Bacchi-Reggiani
authors: Angelo
authors: A
authors: Branzi
authors: Antonio
authors: A
authors: Marzocchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000401:mortality; D002404:Catheterization / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography