title: Repeated Aortic Balloon Valvuloplasty in Elderly Patients With Aortic Stenosis Who Are Not Candidates for Definitive Treatment.
abstract: OBJECTIVE
  A sizable group of patients with symptomatic aortic stenosis can undergo neither surgical aortic valve replacement nor transcatheter aortic valve implantation. The aim of this study was to assess the potential role of repeated balloon aortic valvuloplasty (BAV) in these patients.
  
  
  METHODS
  Within our local prospective BAV registry, we retrospectively selected 105 patients who underwent ≥2 BAV procedures between 2005 and 2012 because of persisting contraindications to definitive treatment after first BAV. In-hospital outcome and incidence of adverse events at 1, 2, and 3 years were assessed. Mean age was 84 ± 6 years, mean logistic EuroSCORE was 23.6 ± 13.4%.
  
  
  RESULTS
  No intraprocedural deaths occurred. In-hospital events for the 224 BAV procedures were: myocardial infarction, 4%; stroke, 0.9%; vascular complications, 8% (1.8% major); and bleedings, 5.9% (life threatening, 0.9%; major, 1.8%). Acute aortic regurgitation occurred in 6 cases and was always resolved during procedures. Median follow-up was 785 days. Second BAVs showed fewer vascular complications (P<.001) and bleedings (P<.001). Bleedings (odds ratio [OR], 6.88; 95% confidence interval [CI], 1.58-29.88) and vascular complications (OR, 4.8; 95% CI, 1.19-19.31) occurring after the first procedure were independent predictors for subsequent adverse events. All-cause mortality at 1, 2, and 3 years was 15.2%, 41.3%, and 57.2%. Hospital readmission for heart failure was 40.7% at 1-year follow-up, 61.7% at 2-year follow-up, and 77.6% at 3-year follow-up.
  
  
  CONCLUSIONS
  BAV is associated with poor long-term clinical outcome. However, when no other therapeutic options are feasible, a strategy of repeated palliative BAV appears to be safe and is potentially associated with improved clinical outcomes.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bordoni
authors.forename: Carolina
authors.initials: C
authors.lastname: Moretti
authors.forename: Cinzia
authors.initials: C
authors.lastname: Marrozzini
authors.forename: Cristina
authors.initials: C
authors.lastname: Ciuca
authors.forename: Gianni
authors.initials: G
authors.lastname: Dall'Ara
authors.forename: Linda
authors.initials: L
authors.lastname: Taffani
authors.forename: Matteo
authors.initials: M
authors.lastname: Chiarabelli
authors.forename: Nevio
authors.initials: N
authors.lastname: Taglieri
authors.forename: Alessandra
authors.initials: A
authors.lastname: Berardini
authors.forename: Paolo
authors.initials: P
authors.lastname: Guastaroba
authors.forename: Maria Letizia
authors.initials: ML
authors.lastname: Bacchi-Reggiani
authors.forename: Claudio
authors.initials: C
authors.lastname: Rapezzi
authors.forename: Antonio
authors.initials: A
authors.lastname: Marzocchi
authors.affiliation: Institute of Cardiology - University of Bologna Policlinico S. Orsola-Malpighi (Pad 21), Via Massarenti, 9, 40138 Bologna, Italy. francescosaia@hotmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Saia
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D063126:Balloon Valvuloplasty / Q000379:methods*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends