title: Aortic balloon valvuloplasty before transcatheter valve replacement in high-risk patients with aortic stenosis. Cardiac catheterization and echocardiographic hemodynamic study.
abstract: BACKGROUND
  Balloon aortic valvuloplasty (BAV) has been revived as a bridge to transcatheter aortic valve replacement (TAVR). The aim of the current prospective study was to define a safe time period from BAV to TAVR and to determine hemodynamic variables that predict event-free survival after BAV.
  
  
  METHODS
  The present prospective study included 68 consecutive patients with severe aortic stenosis who were treated initially with BAV from 2009 to 2012. Echocardiographic and invasive hemodynamic assessments were performed before BAV. The patients were followed up at regular intervals and events were defined as cardiac hospitalization or death.
  
  
  RESULTS
  Invasive hemodynamic evaluation yielded more favorable results than echocardiographic assessment: aortic stenosis was less severe, cardiac output was higher, and pulmonary capillary wedge pressure (PCWP) was lower. Post-BAV event-free survival was 80.4 % at 30 days, 64.5 % at 6 months, 37 % at 1 year, 22.3 % at 2 years, and 9.3 % at 3 years. After excluding pre-discharge deaths (n = 7), the 30-day event-free survival rate was 90 %. Predictors of events after BAV were atrial fibrillation, cardiogenic shock, elevated euroSCORE (European System for Cardiac Operative Risk Evaluation), elevated PCWP, and elevated pulmonary artery systolic pressure. Invasively measured PCWP was the only independent predictor of events (hazard ratio, 1.07; 95 % confidence interval, 1.03-1.11; p = 0.001).
  
  
  CONCLUSIONS
  A 30-day post-BAV period may be considered a bridge to TAVR. Furthermore, invasive assessment of PCWP before BAV is an independent hemodynamic predictor of events after BAV.
authors.affiliation: 1st Department of Cardiology, AHEPA University Hospital, Stilponos Kiriakidi 1, P.O. 54636, Thessaloniki, Greece. vkamperidis@yahoo.co.uk.
authors.forename: V
authors.initials: V
authors.lastname: Kamperidis
authors.affiliation: 1st Department of Cardiology, AHEPA University Hospital, Stilponos Kiriakidi 1, P.O. 54636, Thessaloniki, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Hadjimiltiades
authors.affiliation: 1st Department of Cardiology, AHEPA University Hospital, Stilponos Kiriakidi 1, P.O. 54636, Thessaloniki, Greece.
authors.forename: S A
authors.initials: SA
authors.lastname: Mouratoglou
authors.affiliation: 1st Department of Cardiology, AHEPA University Hospital, Stilponos Kiriakidi 1, P.O. 54636, Thessaloniki, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Ziakas
authors.affiliation: 1st Department of Cardiology, AHEPA University Hospital, Stilponos Kiriakidi 1, P.O. 54636, Thessaloniki, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Sianos
authors.affiliation: 1st Department of Cardiology, AHEPA University Hospital, Stilponos Kiriakidi 1, P.O. 54636, Thessaloniki, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Sarafidou
authors.affiliation: 1st Department of Cardiology, AHEPA University Hospital, Stilponos Kiriakidi 1, P.O. 54636, Thessaloniki, Greece.
authors.forename: I
authors.initials: I
authors.lastname: Ventoulis
authors.affiliation: 1st Department of Cardiology, AHEPA University Hospital, Stilponos Kiriakidi 1, P.O. 54636, Thessaloniki, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Kazinakis
authors.affiliation: 1st Department of Cardiology, AHEPA University Hospital, Stilponos Kiriakidi 1, P.O. 54636, Thessaloniki, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Giannakoulas
authors.affiliation: 1st Department of Cardiology, AHEPA University Hospital, Stilponos Kiriakidi 1, P.O. 54636, Thessaloniki, Greece.
authors.forename: G K
authors.initials: GK
authors.lastname: Efthimiadis
authors.affiliation: 1st Department of Cardiology, AHEPA University Hospital, Stilponos Kiriakidi 1, P.O. 54636, Thessaloniki, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Parcharidis
authors.affiliation: 1st Department of Cardiology, AHEPA University Hospital, Stilponos Kiriakidi 1, P.O. 54636, Thessaloniki, Greece.
authors.forename: H
authors.initials: H
authors.lastname: Karvounis
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D063126:Balloon Valvuloplasty / Q000379:methods / Q000401:mortality*; D001795:Blood Pressure Determination / Q000706:statistics & numerical data; D006328:Cardiac Catheterization / Q000706:statistics & numerical data*; D003131:Combined Modality Therapy / Q000379:methods / Q000401:mortality; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000401:mortality; D015995:Prevalence; D012307:Risk Factors; D015996:Survival Rate; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods / Q000401:mortality*; D016896:Treatment Outcome
keywords: Balloon aortic valvuloplasty; Event-free survival; Invasive hemodynamics; Severe aortic stenosis; Transcatheter aortic valve replacement