title: Balloon aortic valvuloplasty--ups and downs--are we facing a procedure comeback?
abstract: BACKGROUND
  Recently, there has been renewed interest in balloon aortic valvuloplasty (BAV).
  
  
  OBJECTIVE
  To analyse the indications and short-term outcome of BAV since transcatheter aortic valve implantation (TAVI) was launched in our institution.
  
  
  METHODS
  Between September 2010 and September 2014, 25 consecutive patients (19 female, 6 male) underwent BAV. The mean age was 72 ± 11.4 years, mean EuroScore II was 10.4 ± 11.7%, mean logistic EuroScore 23.5 ± 23.6%, mean Society of Thoracic Surgeons mortality risk score was 21.8 ± 13.6%. The indications for BAV were: advanced haemodynamically unstable heart failure (HF) including cardiogenic shock or pulmonary oedema (n = 7), co-morbidities requiring urgent non-cardiac surgery (n = 8), palliative treatment (n = 6), and an intention to bridge to TAVI or aortic valve replacement in patients with severe HF (n = 4).
  
  
  RESULTS
  In-hospital mortality was 20% (n = 5) and occurred in patients who underwent BAV in the setting of haemodynamically unstable HF. Other major complications included pacemaker implantation (n = 2), major vascular complications (n = 4), and cardiac tamponade (n = 1). There were no patients who required conversion to cardiac surgery. The mean peak aortic transvalvular gradient decreased from 96.9 ± 29.5 to 60.3 ± 15.5 mm Hg (p = 0.0001) after BAV. We did not observe significant aortic regurgitation.
  
  
  CONCLUSIONS
  Treatment of advanced and haemodynamically unstable aortic stenosis, bridge to non-cardiac surgery and palliative therapy are the main reasons for BAV in recent years. BAV as a bridge to TAVI or aortic valve replacement may be an option for some patients. Short-term results are good with relatively low mortality and morbidity related to the procedure. Mortality in haemodynamically unstable patients presenting with cardiogenic shock or pulmonary oedema treated with BAV is very high.
authors: 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland. anna.olasinska@poczta.onet.pl.
authors: Anna
authors: A
authors: Olasińska-Wiśniewska
authors: Marek
authors: M
authors: Grygier
authors: Maciej
authors: M
authors: Lesiak
authors: Olga
authors: O
authors: Trojnarska
authors: Aleksander
authors: A
authors: Araszkiewicz
authors: Marcin
authors: M
authors: Misterski
authors: Piotr
authors: P
authors: Buczkowski
authors: Marcin
authors: M
authors: Ligowski
authors: Marek
authors: M
authors: Jemielity
authors: Stefan
authors: S
authors: Grajek
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000401:mortality / Q000601:surgery; D063126:Balloon Valvuloplasty; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000401:mortality / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011654:Pulmonary Edema / Q000150:complications; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000150:complications / Q000601:surgery; D016896:Treatment Outcome
keywords: aortic valve stenosis; cardiac surgery; percutaneous aortic balloon valvuloplasty; transcatheter