title: Balloon aortic valvuloplasty as a bridge-to-decision in high risk patients with aortic stenosis: a new paradigm for the heart team decision making.
abstract: BACKGROUND
  Whilst the majority of the patients with severe aortic stenosis can be directly addressed to surgical aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI), in some instances additional information may be needed to complete the diagnostic workout. We evaluated the role of balloon aortic valvuloplasty (BAV) as a bridge-to-decision (BTD) in selected high-risk patients.
  
  
  METHODS
  Between 2007 and 2012, the heart team in our Institution required BTD BAV in 202 patients. Very low left ventricular ejection fraction, mitral regurgitation grade ≥ 3, frailty, hemodynamic instability, serious comorbidity, or a combination of these factors were the main drivers for this strategy. We evaluated how BAV influenced the final treatment strategy in the whole patient group and in each specific subgroup.
  
  
  RESULTS
  Mean logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 23.5% ± 15.3%, age 81 ± 7 years. In-hospital mortality was 4.5%, cerebrovascular accident 1% and overall vascular complications 4% (0.5% major; 3.5% minor). Of the 193 patients with BTD BAV who survived and received a second heart team evaluation, 72.6% were finally deemed eligible for definitive treatment (25.4% for AVR; 47.2% for TAVI): 96.7% of patients with left ventricular ejection fraction recovery; 70.5% of patients with mitral regurgitation reduction; 75.7% of patients who underwent BAV in clinical hemodynamic instability; 69.2% of frail patients and 68% of patients who presented serious comorbidities.
  
  
  CONCLUSIONS
  Balloon aortic valvuloplasty can be considered as bridge-to-decision in high-risk patients with severe aortic stenosis who cannot be immediate candidates for definitive transcatheter or surgical treatment.
authors: Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy.
authors: Francesco
authors: F
authors: Saia
authors: Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy.
authors: Carolina
authors: C
authors: Moretti
authors: Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy.
authors: Gianni
authors: G
authors: Dall'Ara
authors: Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy.
authors: Cristina
authors: C
authors: Ciuca
authors: Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy.
authors: Nevio
authors: N
authors: Taglieri
authors: Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy.
authors: Alessandra
authors: A
authors: Berardini
authors: Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy.
authors: Pamela
authors: P
authors: Gallo
authors: Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy.
authors: Marina
authors: M
authors: Cannizzo
authors: Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy.
authors: Matteo
authors: M
authors: Chiarabelli
authors: Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy.
authors: Niccolò
authors: N
authors: Ramponi
authors: Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy.
authors: Linda
authors: L
authors: Taffani
authors: Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy.
authors: Maria Letizia
authors: ML
authors: Bacchi-Reggiani
authors: Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy.
authors: Cinzia
authors: C
authors: Marrozzini
authors: Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy.
authors: Claudio
authors: C
authors: Rapezzi
authors: Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy.
authors: Antonio
authors: A
authors: Marzocchi
keywords: Aortic valve replacement; Aortic valve stenosis; Heart team; Mitral valve regurgitation; Transcatheter aortic valve implantation