title: Balloon aortic valvuloplasty in high risk aortic stenosis patients with left ventricular ejection fractions <20%.
abstract: OBJECTIVE
  To determine outcomes following balloon aortic valvuloplasty (BAV) in aortic stenosis (AS) patients with a left ventricular ejection fraction (LVEF) <20%.
  
  
  BACKGROUND
  Severe AS patients with a LVEF <20% are excluded from United States (U.S.) transcatheter aortic valve replacement (TAVR) trials and often surgical aortic valve replacement (AVR). The role for BAV to enhance LVEF is unclear.
  
  
  METHODS
  Our BAV database of 270 consecutive patients extending from 2005 through 2010 was queried for a preoperative LVEF <20%. Demographics, echocardiograms, procedural technique, and outcomes were analyzed. Pre- and postoperative echocardiograms were used to determine improvement in aortic valve area (AVA) and LVEF.
  
  
  RESULTS
  Sixteen patients were identified with a median age of 82 years. The composite Society of Thoracic Surgeons' (STS) mortality risk was 16.4%. The median preoperative AVA and LVEF were 0.60 cm(2) and 16%, respectively, and postoperative AVA and LVEF were 0.77 cm(2) and LVEF 19%, respectively. About 15 of the 16 patients had postoperative echocardiograms available for comparison. And 7 of these 15 (47%) demonstrated improvement in LVEF to ≥20% (median LVEF 25%). The absence of coronary disease and improvement in AVA of ≥0.2 cm(2) was associated with postoperative LVEF of ≥20%. Procedural mortality was 0%. The 30-day, 6-month, and 1-year survival was 69%, 56%, and 29%. STS's mortality risk score ≥15% was associated with short-term mortality.
  
  
  CONCLUSIONS
  With appropriate technique, BAV can be reasonably safe in patients with LVEF <20%. Roughly half of these patients demonstrated improvement in LVEF to ≥20%.
authors: Structural Heart Disease Program, Cardiovascular Services, Minneapolis Heart Institute® at Abbott Northwestern Hospital, Minneapolis, Minnesota; Research Department, Minneapolis Heart Institute Foundation™, Minneapolis, Minnesota.
authors: Wes R
authors: WR
authors: Pedersen
authors: Irvin F
authors: IF
authors: Goldenberg
authors: Christopher W
authors: CW
authors: Pedersen
authors: Andrew
authors: A
authors: Lesser
authors: Kevin M
authors: KM
authors: Harris
authors: John R
authors: JR
authors: Lesser
authors: Ross F
authors: RF
authors: Garberich
authors: Jonathan G
authors: JG
authors: Schwartz
authors: Emily
authors: E
authors: Shank
authors: Robert S
authors: RS
authors: Schwartz
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000628:therapy*; D063126:Balloon Valvuloplasty / Q000379:methods*; D006328:Cardiac Catheterization; D016009:Chi-Square Distribution; D016208:Databases, Factual; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000628:therapy*
keywords: balloon aortic valvuloplasty; severe LV dysfunction; severe aortic stenosis