Balloon aortic valvuloplasty of severe aortic stenosis in the era of TAVR

Abstract

alciic stenosis of the aoric valve (AS) is the most common acquired valve disorder in the Western world 1. Surgical aoric valve replacement (SAVR) is considered the treatment of choice in paients with symptomaic AS regardless of age 2, 3. The surgical risk in elderly paients with muliple comorbidiies may be high and the presence of concomitant coronary artery disease (CAD) with the need for addiional coronary artery bypass may duplicate the risk 4-6. Balloon aoric valvuloplasty (BAV) was introduced in 1986 as the irst less invasive percutaneous treatment opion of symptomaic AS 7. Unfortunately, early restenosis of the dilated valve with symptoms recurrence and poor long-term survival limits the use of this procedure 8-12. Today BAV may be considered as a bridge to surgery or percutaneous aoric valve replacement (TA-VR) in haemodynamic unstable paients or paients that require urgent major non-cardiac surgery. Balloon valvuloplasty may also be considered as a palliative measure in selected individual cases when surgery is contraindicated because of severe comorbidiies and when TAVR is not an opion 13. Percutaneous aoric valve treatment program started in our medical centre in 2008 as a part of preparaion for TAVR program. BAV was not frequently used in our centre before. Since 2008 we performed over 330 BAV procedures and 110 TAVR implantaions. The present study evaluated all the BAV procedures we performed in 2010 and reports our experience with BAV in symptomaic high risk paients with severe aoric stenosis, as a potenial bridge to deiniive therapy or as a palliaive treatment. Methods Paient populaion and selecion We retrospecively analyzed all the paients who underwent percutaneous treatment of aoric stenosis in our insituion between January and December 2010. We straiied our cohort into 3 groups according to the