title: Incidence, treatment, and outcome of acute aortic valve regurgitation complicating percutaneous balloon aortic valvuloplasty.
abstract: OBJECTIVE
  To evaluate the incidence, treatment, and outcomes of acute aortic regurgitation (ARR) complicating BAV.
  
  
  BACKGROUND
  In the transcatheter aortic valve implantation (TAVI) era, there is an increase of percutaneous balloon aortic valvuloplasty (BAV) procedures with different indications.
  
  
  METHODS
  From the prospective BAV registry of the University of Bologna, which has enrolled patients between the year 2000 and the present, we selected those who suffered intraprocedural AAR with overt hemodynamic instability. Worsening of baseline aortic insufficiency without hemodynamic collapse, treatment of degenerated biological valve prosthesis, and BAV performed within a planned TAVI procedure were excluded. The main endpoints were in-hospital and 30-day mortality.
  
  
  RESULTS
  Out of 1517 BAVs, we identified 26 cases of AAR (1.7%). This complication occurred in 80.8% of cases after one or two balloon inflations. Mean transaortic gradient decreased from 50.6 ± 19.3 to 26.0 ± 14.4 mm Hg (p < 0.01). In 8(30.8%) patients, AAR spontaneously resolved within few minutes; in 18 cases, the operators had to perform a rescue maneuver to reposition a valve leaflet got stuck in the opening position (this maneuver was successful in 13/18 of the cases, 72.2%). Out of 5 persistent AAR, 3 were managed with emergency TAVI or surgery, while 2 were unresolved. In-hospital mortality was 15.4% (n = 4), whereas no more deaths occurred up to 30 days.
  
  
  CONCLUSIONS
  AAR is a fearsome complication of BAV and portends a grim prognosis. In some cases, it can be resolved with appropriate technical maneuvers; in others, a rescue TAVI or surgical valve replacement may be necessary. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Policlinico S. Orsola-Malpighi, Cardiology Unit, University of Bologna, Bologna, Italy.|Dottorato Di Ricerca XXX° Ciclo, Scienze Cardio-Nefro-Toraciche, University of Bologna, Bologna, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Dall'Ara
authors.affiliation: Policlinico S. Orsola-Malpighi, Cardiology Unit, University of Bologna, Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Saia
authors.affiliation: Policlinico S. Orsola-Malpighi, Cardiology Unit, University of Bologna, Bologna, Italy.
authors.forename: Carolina
authors.initials: C
authors.lastname: Moretti
authors.affiliation: Policlinico S. Orsola-Malpighi, Cardiology Unit, University of Bologna, Bologna, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Marrozzini
authors.affiliation: Policlinico S. Orsola-Malpighi, Cardiology Unit, University of Bologna, Bologna, Italy.
authors.forename: Nevio
authors.initials: N
authors.lastname: Taglieri
authors.affiliation: Policlinico S. Orsola-Malpighi, Cardiology Unit, University of Bologna, Bologna, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bordoni
authors.affiliation: Policlinico S. Orsola-Malpighi, Cardiology Unit, University of Bologna, Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Chiarabelli
authors.affiliation: Policlinico S. Orsola-Malpighi, Cardiology Unit, University of Bologna, Bologna, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Ciuca
authors.affiliation: Policlinico S. Orsola-Malpighi, Cardiology Unit, University of Bologna, Bologna, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Rapezzi
authors.affiliation: Policlinico S. Orsola-Malpighi, Cardiology Unit, University of Bologna, Bologna, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Marzocchi
mesh_terms: D000208:Acute Disease; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D063126:Balloon Valvuloplasty / Q000009:adverse effects*; D006328:Cardiac Catheterization / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: acute aortic regurgitation; aortic stenosis; balloon aortic valvuloplasty; complications