title: Patients with small left ventricular size undergoing balloon aortic valvuloplasty have worse intraprocedural outcomes.
abstract: OBJECTIVE
  To evaluate the impact of left ventricular (LV) chamber size on procedural and hospital outcomes of patients undergoing aortic valvuloplasty.
  
  
  BACKGROUND
  Balloon aortic valvuloplasty (BAV) is used as an integral step during transcatheter aortic valve implantation. Patients with small, thickened ventricles are thought to have more complications during and following BAV.
  
  
  METHODS
  Retrospective study of consecutive patients with severe, symptomatic calcific aortic stenosis who underwent retrograde BAV at Massachusetts General Hospital. We compared patients with left ventricular end-diastolic diameters (LVEDD) <4.0 cm (n = 31) to those with LVEDD ≥4.0 cm (n = 78). Baseline and procedural characteristics as well as clinical outcomes were compared. Multivariate logistic regression was used for the adjusted analysis.
  
  
  RESULTS
  Patients with smaller LV chamber size were mostly women (80.7% vs. 19.4%, P < 0.01) and had a smaller body surface area (BSA), (1.61 ± 0.20 m(2) vs. 1.79 ± 0.25 m(2) , P < 0.01). Patients with smaller LV chamber size had higher ejection fractions and thicker ventricles. Otherwise, baseline characteristics were similar. The intraprocedural composite of death, cardiopulmonary arrest, intubation, hemodynamic collapse, and tamponade was higher for patients with LVEDD < 4.0 cm (32.3% v. 11.5%, P = 0.01). Adjusting for age, gender, BSA, LV pressure, and New York Heart Association class, LVEDD < 4.0 cm remained an independent predictor of procedural (OR 5.1, 95% CI 1.4-18.2) and in-hospital complications (OR 3.8, 95% CI 1.2-11.6).
  
  
  CONCLUSIONS
  Compared to patients undergoing BAV with LVEDD ≥4.0 cm, those with smaller LV chambers had worse procedural and in-hospital outcomes.
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. cwdon@u.washington.edu
authors.forename: Creighton
authors.initials: C
authors.lastname: Don
authors.forename: Pritha P
authors.initials: PP
authors.lastname: Gupta
authors.forename: Christian
authors.initials: C
authors.lastname: Witzke
authors.forename: Manoj
authors.initials: M
authors.lastname: Kesarwani
authors.forename: Roberto J
authors.initials: RJ
authors.lastname: Cubeddu
authors.forename: Ignacio
authors.initials: I
authors.lastname: Inglessis
authors.forename: Igor F
authors.initials: IF
authors.lastname: Palacios
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D063126:Balloon Valvuloplasty / Q000009:adverse effects*; D001830:Body Surface Area; D001900:Boston; D002114:Calcinosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006769:Hospitals, General; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D016896:Treatment Outcome; D014463:Ultrasonography; D016277:Ventricular Function, Left