We aim to evaluate the contemporary role and outcomes of balloon aortic valvuloplasty
(BAV), based on physician intent, for the management of severe aortic stenosis. This
is a prospective, 2-center study of 100 consecutive high-risk patients with severe
aortic stenosis who underwent BAV. Before BAV, physicians assigned intent as (1) bridge
to decision (BTD); (2) therapeutic bridge to planned therapy; or (3) palliation. Patients
in the BTD arm underwent clinical assessment at 30 days to determine eligibility for
definitive valve therapy. All patients were followed up to 1 year, with outcomes measured
including procedural complications, Kansas City Cardiomyopathy Questionnaires scores,
30-day and 1-year mortality, and definitive valve therapy. Enrolled patients had a
mean age of 80.6 (±9.6) years, Society of Thoracic Surgeons predicted risk of mortality
of 11.4% (±7.1%), and 91 (91.0%) patients had class III or IV New York Heart Association
congestive heart failure. Intent in the 100 study patients was 76 BTD; 20 therapeutic
bridge to planned therapy; and 4 palliation. Thirty-day mortality for all patients
was 6 of 100 (6.0%), and 1-year mortality for all patients who received definitive
valve therapy was 6 of 54 (11.1%). For patients surviving to 30 days, adjusted (by
Society of Thoracic Surgeons predicted risk of mortality) Kansas City Cardiomyopathy
Questionnaires scores were significantly improved from baseline for all patients and
BTD patients. In conclusion, as a bridge to decision and treatment tool, BAV appears
to have a valuable role in properly selecting and improving patients to undergo definitive
valve replacement.
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Article Info
Publication History
Published online: July 25, 2017
Accepted:
July 3,
2017
Received:
March 12,
2017
Footnotes
MM serves as an uncompensated member of the Executive Committee of the PARTNER Trial; the remaining authors have no disclosures relevant to this manuscript.
See page 1372 for disclosure information.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
