title: Balloon valvuloplasty as destination therapy in elderly with severe aortic stenosis: a cardiac catheterization study.
abstract: BACKGROUND
  In the current era of transcatheter aortic valve replacement, there is renewed interest in balloon aortic valvuloplasty (BAV) and invasive hemodynamic evaluation of aortic stenosis (AS). The current report aimed to study the invasive hemodynamics of severe AS patients treated with BAV as destination therapy and to identify factors associated with better hemodynamic outcome and prognosis.
  
  
  METHODS
  From 2009 to 2012, 63 high risk elderly patients were treated with BAV as destination therapy for symptomatic severe AS and were all prospectively included in the study. Their hemodynamics were invasively evaluated during catheterization, pre- and post-BAV at the same session. All Post-BAV patients were regularly followed-up.
  
  
  RESULTS
  The patients (82 ± 6 years, 52% male) had post-BAV aortic valve area index (AVAi) significantly increased and mean pressure gradient (MPG) significantly reduced. During the follow-up of 0.9 (maximum 3.3) years, those with post-BAV AVAi < 0.6 cm(2)/m(2) compared with the AVAi ≥ 0.6 cm(2)/m(2) group had significantly higher mortality (60% vs. 28%, log-rank P = 0.02), even after adjusting for age, gender, atrial fibrillation, chronic kidney disease, diabetes mellitus, coronary artery disease and EuroSCORE [HR: 5.58, 95% confidence interval (CI): 1.62-19.20, P = 0.006]. The only independent predictor of moderate AS post-BAV was the pre-BAV AVAi increase by 0.1cm(2)/m(2) (OR: 3.81, 95% CI: 1.33-10.89, P = 0.01). Pre-BAV AVAi ≥ 0.39 cm(2)/m(2) could predict with sensitivity 84% and specificity 70% the post-BAV hemodynamic outcome.
  
  
  CONCLUSIONS
  BAV as destination therapy for severe AS offered immediate and significant hemodynamic improvement. The survival was significantly better when a moderate degree of AS was present.
authors.affiliation: The First Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Kamperidis
authors.affiliation: The First Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece.
authors.forename: Stavros
authors.initials: S
authors.lastname: Hadjimiltiades
authors.affiliation: The First Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece.
authors.forename: Antonios
authors.initials: A
authors.lastname: Ziakas
authors.affiliation: The First Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Sianos
authors.affiliation: The First Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Kazinakis
authors.affiliation: The First Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Giannakoulas
authors.affiliation: The First Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece.
authors.forename: Sophia-Anastasia
authors.initials: SA
authors.lastname: Mouratoglou
authors.affiliation: The First Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece.
authors.forename: Athanasia
authors.initials: A
authors.lastname: Sarafidou
authors.affiliation: The First Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Ventoulis
authors.affiliation: The First Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece.
authors.forename: Georgios K
authors.initials: GK
authors.lastname: Efthimiadis
authors.affiliation: The First Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Parcharidis
authors.affiliation: The First Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece.
authors.forename: Haralambos
authors.initials: H
authors.lastname: Karvounis
keywords: Balloon aortic valvuloplasty; Invasive hemodynamics; Outcome; Severe aortic stenosis; The elderly