Balloon aortic valvuloplasty in the era of transcatheter aortic valve replacement: acute and long-term outcomes.
BACKGROUND
The use of balloon aortic valvuloplasty (BAV) has resurged since the development of transcatheter aortic valve replacement (TAVR). The aim of our study was to determine the procedural and long-term outcomes of patients treated by BAV in the early TAVR era.


METHODS
From 2005 to 2008, 323 consecutive patients presenting with severe aortic stenosis were treated by BAV in our institution.


RESULTS
Mean age and logistic EuroSCORE were 80.5 ± 9.9 years and 28.7% ± 12.5%, respectively. The effective orifice area increased from 0.68 ± 0.25 to 1.12 ± 0.39 cm(2) (P < .001) after BAV. Inhospital major complications occurred in 22 patients (6.8%), with a mortality rate of 2.5%. Eighty-five patients (26.3%) were bridged to surgical aortic valve replacement (SAVR, 9.6%) or TAVR (16.7%). Twenty-eight patients (8.7%) had at least 1 repeat BAV. Two hundred ten patients (65%) received only medical therapy post-BAV. Mean duration of follow-up was 20.7 ± 20.0 months. Kaplan-Meier analysis demonstrated that survival after single BAV was poor. Patients treated by BAV followed by SAVR or TAVR had the highest long-term survival rate (P < .001). Multivariable analysis revealed that logistic EuroSCORE, severe aortic regurgitation and stroke complications post-BAV, and medical therapy post-BAV were independent predictors of mortality.


CONCLUSIONS
The results of our study suggest that BAV is an acceptable bridge to SAVR or TAVR in a very high-risk population not immediately suitable for definitive therapy. Balloon aortic valvuloplasty remains only a brief temporizing procedure with a poor long-term outcome without subsequent definitive therapy.
Department of Cardiology, University Hospital of Rouen, Hospital Charles Nicolle, INSERM U1096, Rouen, France. Electronic address: helene.eltchaninoff@chu-rouen.fr.
Hélène
H
Eltchaninoff
Department of Cardiology, University Hospital of Rouen, Hospital Charles Nicolle, INSERM U1096, Rouen, France.
Eric
E
Durand
Department of Cardiology, University Hospital of Rouen, Hospital Charles Nicolle, INSERM U1096, Rouen, France.
Bogdan
B
Borz
Department of Cardiology, University Hospital of Rouen, Hospital Charles Nicolle, INSERM U1096, Rouen, France.
Akira
A
Furuta
Department of Cardiology, University Hospital of Rouen, Hospital Charles Nicolle, INSERM U1096, Rouen, France.
Karim
K
Bejar
Department of Cardiology, University Hospital of Rouen, Hospital Charles Nicolle, INSERM U1096, Rouen, France.
Alexandre
A
Canville
Department of Cardiology, University Hospital of Rouen, Hospital Charles Nicolle, INSERM U1096, Rouen, France.
Ali
A
Farhat
Department of Cardiology, University Hospital of Rouen, Hospital Charles Nicolle, INSERM U1096, Rouen, France.
Chiara
C
Fraccaro
Department of Cardiology, University Hospital of Rouen, Hospital Charles Nicolle, INSERM U1096, Rouen, France.
Matthieu
M
Godin
Department of Cardiology, University Hospital of Rouen, Hospital Charles Nicolle, INSERM U1096, Rouen, France.
Christophe
C
Tron
Department of Interventional Cardiology, Wellmont CVA Heart Institute, Kingsport, TN.
Rahul
R
Sakhuja
Department of Cardiology, University Hospital of Rouen, Hospital Charles Nicolle, INSERM U1096, Rouen, France.
Alain
A
Cribier
D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D063126:Balloon Valvuloplasty / Q000379:methods*; D006328:Cardiac Catheterization / Q000379:methods*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome