Clinical outcomes following balloon aortic valvuloplasty

Abstract

Background: Balloon aortic valvuloplasty (BAV) remains a treatment option for the selected patients with severe aortic stenosis. We examined clinical outcomes and predictors of prognosis in patients undergoing BAV for severe aortic stenosis.

Methods: We identified all patients undergoing BAV from January 2010 to March 2018 (n=167) at a single transcatheter aortic valve implantation (TAVI) centre. Patient demographics, investigations, subsequent interventions and clinical outcomes were obtained from electronic health records.

Results: Patients undergoing BAV were elderly (median age 80, IQR 73-86 years) and half (n=87, 52%) were male. All-cause mortality at 30 days and 12 months was 11% and 43%, respectively. Reduce ejection fraction (EF 30%-50%: HR 1.76, 95% CI 1.05 to 2.94; EF <30%: HR 1.90, 95% CI 1.12 to 3.20) was the only independent predictor at baseline of overall mortality. Median survival was 212 (IQR 54-490) days from the index procedure. Mortality at 1 year was lowest in patients who subsequently underwent TAVI or SAVR but high among those who had no further interventions or those who had a repeat BAV (14%, 19%, 60%, 89% respectively, log-rank p<0.001).

Conclusion: BAV as a bridge to definitive aortic valve intervention in carefully selected patients offers acceptable outcomes. These contemporary observational findings demonstrate the ongoing potential utility of BAV in the TAVI era.

Keywords: aortic valve disease; percutaneous valve therapy; valvuloplasty.

Figure 1

Quarterly rates of BAV and subsequent repeat intervention during the study period of January 2010 to March 2018. (TAVI was introduced in the Edinburgh Heart Centre in the last quarter of 2012.) Online supplemental table 3 outlines the number of procedures per year. BAV, balloon aortic valvuloplasty; TAVI, transcatheter aortic valve implantation.

Figure 2

Panel plot showing Kaplan-Meier survival curves and corresponding number at risk tables stratified by (A) repeat intervention and (B) index BAV procedure priority. Groups are compared using the log-rank test. BAV, balloon aortic valvuloplasty; SAVR, surgical aortic valve replacement; TAVI, transcatheter aortic valve implantation.