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Usefulness of Balloon Aortic Valvuloplasty in the Management of Patients With Aortic Stenosis

      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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      References

        • Cribier A.
        • Savin T.
        • Saoudi N.
        • Rocha P.
        • Berland J.
        • Letac B.
        Percutaneous transluminal valvuloplasty of acquired aortic stenosis in elderly patients: an alternative to valve replacement?.
        Lancet. 1986; 1: 63-67
      1. Percutaneous balloon aortic valvuloplasty. Acute and 30-day follow-up results in 674 patients from the NHLBI Balloon Valvuloplasty Registry.
        Circulation. 1991; 84: 2383-2397
        • Lieberman E.B.
        • Bashore T.M.
        • Hermiller J.B.
        • Wilson J.S.
        • Pieper K.S.
        • Keeler G.P.
        • Pierce C.H.
        • Kisslo K.B.
        • Harrison J.K.
        • Davidson C.J.
        Balloon aortic valvuloplasty in adults: failure of procedure to improve long-term survival.
        J Am Coll Cardiol. 1995; 26: 1522-1528
        • Letac B.
        • Cribier A.
        • Koning R.
        • Bellefleur J.P.
        Results of percutaneous transluminal valvuloplasty in 218 adults with valvular aortic stenosis.
        Am J Cardiol. 1988; 62: 598-605
        • Ben-Dor I.
        • Pichard A.D.
        • Satler L.F.
        • Goldstein S.A.
        • Syed A.I.
        • Gaglia Jr, M.A.
        • Weissman G.
        • Maluenda G.
        • Gonzalez M.A.
        • Wakabayashi K.
        • Collins S.D.
        • Torguson R.
        • Okubagzi P.
        • Xue Z.
        • Kent K.M.
        • Lindsay J.
        • Waksman R.
        Complications and outcome of balloon aortic valvuloplasty in high-risk or inoperable patients.
        JACC Cardiovasc Interv. 2010; 3: 1150-1156
        • Vahanian A.
        • Alfieri O.
        • Andreotti F.
        • Antunes M.J.
        • Baron-Esquivias G.
        • Baumgartner H.
        • Borger M.A.
        • Carrel T.P.
        • De Bonis M.
        • Evangelista A.
        • Falk V.
        • Lung B.
        • Lancellotti P.
        • Pierard L.
        • Price S.
        • Schafers H.J.
        • Schuler G.
        • Stepinska J.
        • Swedberg K.
        • Takkenberg J.
        • Von Oppell U.O.
        • Windecker S.
        • Zamorano J.L.
        • Zembala M.
        • ESC Committee for Practice Guidelines (CPG)
        • Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC)
        • European Association for Cardio-Thoracic Surgery (EACTS)
        Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS).
        Eur J Cardiothorac Surg. 2012; 42: S1-S44
        • Nishimura R.A.
        • Otto C.M.
        • Bonow R.O.
        • Carabello B.A.
        • Erwin 3rd, J.P.
        • Guyton R.A.
        • O'Gara P.T.
        • Ruiz C.E.
        • Skubas N.J.
        • Sorajja P.
        • Sundt 3rd, T.M.
        • Thomas J.D.
        • American College of Cardiology/American Heart Association Task Force on Practice Guidelines
        2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
        J Am Coll Cardiol. 2014; 63: 2438-2488
        • Afilalo J.
        • Alexander K.P.
        • Mack M.J.
        • Maurer M.S.
        • Green P.
        • Allen L.A.
        • Popma J.J.
        • Ferrucci L.
        • Forman D.E.
        Frailty assessment in the cardiovascular care of older adults.
        J Am Coll Cardiol. 2014; 63: 747-762
        • Spertus J.A.
        • Jones P.G.
        Development and validation of a short version of the Kansas City Cardiomyopathy Questionnaire.
        Circ Cardiovasc Qual Outcomes. 2015; 8: 469-476
        • O'Brien S.M.
        • Shahian D.M.
        • Filardo G.
        • Ferraris V.A.
        • Haan C.K.
        • Rich J.B.
        • Normand S.L.
        • DeLong E.R.
        • Shewan C.M.
        • Dokholyan R.S.
        • Peterson E.D.
        • Edwards F.H.
        • Anderson R.P.
        • Society of Thoracic Surgeons Quality Measurement Task Force
        The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2—isolated valve surgery.
        Ann Thorac Surg. 2009; 88: S23-S42
        • Filardo G.
        • Hamilton C.
        • Hamman B.
        • Ng H.K.
        • Grayburn P.
        Categorizing BMI may lead to biased results in studies investigating in-hospital mortality after isolated CABG.
        J Clin Epidemiol. 2007; 60: 1132-1139
        • Harrell Jr, F.
        Regression modeling strategies: with application to linear models, logistic regression, and survival analysis.
        Springer-Verlag, New York2001
        • McKay R.G.
        The Mansfield Scientific Aortic Valvuloplasty Registry: overview of acute hemodynamic results and procedural complications.
        J Am Coll Cardiol. 1991; 17: 485-491
        • Eltchaninoff H.
        • Durand E.
        • Borz B.
        • Furuta A.
        • Bejar K.
        • Canville A.
        • Farhat A.
        • Fraccaro C.
        • Godin M.
        • Tron C.
        • Sakhuja R.
        • Cribier A.
        Balloon aortic valvuloplasty in the era of transcatheter aortic valve replacement: acute and long-term outcomes.
        Am Heart J. 2014; 167: 235-240
        • Kapadia S.
        • Stewart W.J.
        • Anderson W.N.
        • Babaliaros V.
        • Feldman T.
        • Cohen D.J.
        • Douglas P.S.
        • Makkar R.R.
        • Svensson L.G.
        • Webb J.G.
        • Wong S.C.
        • Brown D.L.
        • Miller D.C.
        • Moses J.W.
        • Smith C.R.
        • Leon M.B.
        • Tuzcu E.M.
        Outcomes of inoperable symptomatic aortic stenosis patients not undergoing aortic valve replacement: insight into the impact of balloon aortic valvuloplasty from the PARTNER trial (Placement of AoRtic TraNscathetER Valve trial).
        JACC Cardiovasc Interv. 2015; 8: 324-333
        • Nishimura R.A.
        • Otto C.M.
        • Bonow R.O.
        • Carabello B.A.
        • Erwin 3rd, J.P.
        • Fleisher L.A.
        • Jneid H.
        • Mack M.J.
        • McLeod C.J.
        • O'Gara P.T.
        • Rigolin V.H.
        • Sundt 3rd, T.M.
        • Thompson A.
        2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
        J Am Coll Cardiol. 2017; 70: 252-289https://doi.org/10.1016/j.jacc.2017.03.011
        • Doguet F.
        • Godin M.
        • Lebreton G.
        • Eltchaninoff H.
        • Cribier A.
        • Bessou J.P.
        • Litzler P.Y.
        Aortic valve replacement after percutaneous valvuloplasty—an approach in otherwise inoperable patients.
        Eur J Cardiothorac Surg. 2010; 38: 394-399
        • Kefer J.
        • Gapira J.M.
        • Pierrard S.
        • DeMeester C.
        • Gurne O.
        • Chenu P.
        • Renkin J.
        Recovery after balloon aortic valvuloplasty in patients with aortic stenosis and impaired left ventricular function: predictors and prognostic implications.
        J Invasive Cardiol. 2013; 25: 235-241
        • Kapadia S.R.
        • Goel S.S.
        • Yuksel U.
        • Agarwal S.
        • Pettersson G.
        • Svensson L.G.
        • Smedira N.G.
        • Whitlow P.L.
        • Lytle B.W.
        • Tuzcu E.M.
        Lessons learned from balloon aortic valvuloplasty experience from the pre-transcatheter aortic valve implantation era.
        J Interv Cardiol. 2010; 23: 499-508
        • Schwarz F.
        • Baumann P.
        • Manthey J.
        • Hoffmann M.
        • Schuler G.
        • Mehmel H.C.
        • Schmitz W.
        • Kubler W.
        The effect of aortic valve replacement on survival.
        Circulation. 1982; 66: 1105-1110
        • Ross Jr, J.
        • Braunwald E.
        Aortic stenosis.
        Circulation. 1968; 38: 61-67
        • Arnold S.V.
        • Reynolds M.R.
        • Wang K.
        • Magnuson E.A.
        • Baron S.J.
        • Chinnakondepalli K.M.
        • Reardon M.J.
        • Tadros P.N.
        • Zorn G.L.
        • Maini B.
        • Mumtaz M.A.
        • Brown J.M.
        • Kipperman R.M.
        • Adams D.H.
        • Popma J.J.
        • Cohen D.J.
        • CoreValve US Pivotal Trial Investigators
        Health status after transcatheter or surgical aortic valve replacement in patients with severe aortic stenosis at increased surgical risk: results from the CoreValve US Pivotal Trial.
        JACC Cardiovasc Interv. 2015; 8: 1207-1217
        • Reynolds M.R.
        • Magnuson E.A.
        • Wang K.
        • Thourani V.H.
        • Williams M.
        • Zajarias A.
        • Rihal C.S.
        • Brown D.L.
        • Smith C.R.
        • Leon M.B.
        • Cohen D.J.
        • Investigators P.T.
        Health-related quality of life after transcatheter or surgical aortic valve replacement in high-risk patients with severe aortic stenosis: results from the PARTNER (Placement of AoRTic TraNscathetER Valve) Trial (Cohort A).
        J Am Coll Cardiol. 2012; 60: 548-558
        • Thourani V.H.
        • Jensen H.A.
        • Babaliaros V.
        • Kodali S.K.
        • Rajeswaran J.
        • Ehrlinger J.
        • Blackstone E.H.
        • Suri R.M.
        • Don C.W.
        • Aldea G.
        • Williams M.R.
        • Makkar R.
        • Svensson L.G.
        • McCabe J.M.
        • Dean L.S.
        • Kapadia S.
        • Cohen D.J.
        • Pichard A.D.
        • Szeto W.Y.
        • Herrmann H.C.
        • Devireddy C.
        • Leshnower B.G.
        • Ailawadi G.
        • Maniar H.S.
        • Hahn R.T.
        • Leon M.B.
        • Mack M.
        Outcomes in nonagenarians undergoing transcatheter aortic valve replacement in the PARTNER-I Trial.
        Ann Thorac Surg. 2015; 100 (discussion 793): 785-792