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. 2021 Oct 1;17(8):e680-e687.
doi: 10.4244/EIJ-D-20-01423.

Balloon aortic valvuloplasty for severe aortic stenosis before urgent non-cardiac surgery

Nicolas Debry  1 , Alexandre Altes, Flavien Vincent, Cédric Delhaye, Guillaume Schurtz, Farid Nedjari, Gabin Legros, Sina Porouchani, Augustin Coisne, Marjorie Richardson, Alessandro Cosenza, Basile Verdier, Tom Denimal, Thibault Pamart, Hugues Spillemaeker, Habib Sylla, Arnaud Sudre, Dany Janah, David Aouate, Wassima Marsou, Ludovic Appert, Gilles Lemesle, Julien Labreuche, Sylvestre Maréchaux, Eric Van Belle
Affiliations

Balloon aortic valvuloplasty for severe aortic stenosis before urgent non-cardiac surgery

Nicolas Debry et al. EuroIntervention. .

Abstract

Background: Balloon aortic valvuloplasty (BAV) has been proposed as a therapeutic option in patients suffering from severe aortic stenosis (SAS) who need urgent non-cardiac surgery (NCS). Whether this strategy is better than medical therapy in this very specific population is unknown.

Aims: We aimed to evaluate the clinical benefit of an invasive strategy (IS) with preoperative BAV in patients with SAS requiring urgent NCS.

Methods: From 2011 to 2019, a registry conducted in two centres included 133 patients with SAS undergoing urgent NCS, of whom 93 underwent preoperative BAV (IS) and 40 a conservative strategy (CS) without BAV. All analyses were adjusted for confounding using inverse probability of treatment weighting (IPTW) (10 clinical and anatomical variables).

Results: The primary outcome was MACE at one-month follow-up after NCS including mortality, heart failure, and other cardiovascular outcomes. In patients managed conservatively, occurrence of MACE was 20.0% (n=8) and death was 10.0% (n=4) at 1 month. In patients undergoing BAV, the occurrence of MACE was 20.4% (n=19) and death was 5.4% (n=5) at 1 month. Among patients undergoing conservative management, all events were observed after NCS while, in patients undergoing BAV, 12.9% (n=12) had events between BAV and NCS including 3 deaths, and 7.5% (n=7) had events after NCS including 2 deaths. In IPTW propensity analyses, the incidence of the primary outcome (20.4% vs 20.0%; OR 0.93, 95% CI: 0.38-2.29) and three-month survival (89.2% vs 90.0%; IPTW-adjusted HR 0.90, 95% CI: 0.31-2.60) were similar in both groups.

Conclusions: Patients with SAS managed conservatively before urgent NCS are at high risk of events. A systematic invasive strategy using BAV does not provide a significant improvement in clinical outcome.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Central illustration
Central illustration
Study flow chart.
Figure 1
Figure 1
Three-month survival after NCS in patients with an invasive (BAV) or conservative (without BAV) strategy. BAV: balloon aortic valvuloplasty; NCS: non-cardiac surgery
See this image and copyright information in PMC

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