Standalone balloon aortic valvuloplasty: indications and outcomes from the UK in the transcatheter valve era.
OBJECTIVE
We sought to characterize UK-wide balloon aortic valvuloplasty (BAV) experience in the TAVI era.


BACKGROUND
BAV for acquired calcific aortic stenosis is in a phase of renaissance, largely due to the development of transcatheter aortic valve implantation (TAVI).


METHODS
Data from 423 patients at 14 centers across the UK were analyzed.


RESULTS
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(2) 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, P = 0.018), poor LV function (HR 1.54, 95%CI 1.09-2.16, P = 0.014), and either urgent (HR 1.70, 95%CI 1.18-2.45; P = 0.004) or emergent presentation (HR 3.72, 95%CI 2.27-6.08; P < 0.0001).


CONCLUSIONS
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.
Cardiovascular Division, BHF Center of Excellence, King's College London, St Thomas' Hospital, London, United Kingdom.
Muhammed Z
MZ
Khawaja
Manav
M
Sohal
Haseeb
H
Valli
Rafal
R
Dworakowski
Stephen J
SJ
Pettit
David
D
Roy
James
J
Newton
Heiko
H
Schneider
Ganesh
G
Manoharan
Sagar
S
Doshi
Douglas
D
Muir
David
D
Roberts
James
J
Nolan
Mark
M
Gunning
Cameron
C
Densem
Mark S
MS
Spence
Saqib
S
Chowdhary
Vaikom S
VS
Mahadevan
Stephen J
SJ
Brecker
Philip
P
Maccarthy
Michael
M
Mullen
Rodney H
RH
Stables
Bernard D
BD
Prendergast
Adam
A
de Belder
Martyn
M
Thomas
Simon
S
Redwood
David
D
Hildick-Smith
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D063126:Balloon Valvuloplasty / Q000009:adverse effects / Q000401:mortality; D002114:Calcinosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D006113:United Kingdom