title: Short-term efficacy of palliative balloon aortic valvuloplasty in selected patients with high operative risk.
abstract: With the introduction of transcatheter aortic valve implantation (TAVI), the precise role of balloon aortic valvuloplasty (BAV) remains to be established.
  
  
  METHODS
  Between August 2008 and November 2010, consecutive patients undergoing BAV for severe aortic stenosis (AS) in our center were enrolled. The primary endpoint was survival to hospital discharge. Secondary endpoints were 30-day survival and progression to aortic valve replacement (AVR).
  
  
  RESULTS
  Enrolled were 64 patients (age, 82 ± 8 years; 45% male). Treatment objectives were: symptom palliation (69%); potential AVR (23%); and facilitation of withdrawal of ventilation or non-cardiac surgery (8%). At baseline, patients had logistic EuroSCORE of 35.7 ± 19.5, NT-proBNP of 11,195 ± 11,694 ng/L, aortic valve area of 0.53 ± 0.17 cm², and peak transaortic gradient (PG) of 75.2 ± 25.3 mm Hg. The primary endpoint of survival to hospital discharge was reached by 97% patients. The secondary endpoint of 30-day mortality occurred in 8 patients (13%). Overall, 12 patients showed clinical improvement within 1 month of BAV. Of these, 8 patients underwent AVR (TAVI in 3/8 [38%]). After multivariate adjustment, the strongest correlates for 30-day survival and progression to AVR pre-BAV were: New York Heart Association ≤II, SBP ≥90 mm Hg, estimated glomular filtration rate ≥45 mL min-1, left ventricular ejection fraction ≥45% and transaortic PG <80 mm Hg.
  
  
  CONCLUSIONS
  In patients with severe AS and high operative risk, BAV has the potential to facilitate progression to TAVI in those who are technically suitable.
authors.affiliation: Heart Centre, Royal Victoria Hospital, Grosvenor Road, Belfast, UK. michaeljdaly@hotmail.com
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Daly
authors.forename: Monica
authors.initials: M
authors.lastname: Monaghan
authors.forename: Andrew
authors.initials: A
authors.lastname: Hamilton
authors.forename: Christopher
authors.initials: C
authors.lastname: Lockhart
authors.forename: Vivek
authors.initials: V
authors.lastname: Kodoth
authors.forename: Shevanthi
authors.initials: S
authors.lastname: Pillai
authors.forename: Ganesh
authors.initials: G
authors.lastname: Manoharan
authors.forename: Mark S
authors.initials: MS
authors.lastname: Spence
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D002404:Catheterization; D005260:Female; D006333:Heart Failure / Q000150:complications; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D010166:Palliative Care; D012306:Risk; D015996:Survival Rate