Contemporary Use of Balloon Aortic Valvuloplasty in the Era of Transcatheter Aortic Valve Implantation

Abstract

The development of transcatheter aortic valve implantation (TAVI) has increased the use of balloon aortic valvuloplasty (BAV) (2009)(2010) and TAVI (2011TAVI ( -2012 P ercutaneous balloon aortic valvuloplasty (BAV) was proposed in 1986 by Alain Cribier as an alternative to surgical aortic valve replacement (SAVR) for treating symptomatic aortic stenosis in high-risk patients.1 Poor long-term results in comparison with SAVR relegated BAV to American College of Cardiology/ American Heart Association class IIB indications in patients who are thought to be inoperable. 2 The transcatheter aortic valve implantation (TAVI) technique uses BAV as an essential procedural step to evaluate annular size, to evaluate displacement of the aortic valve leaflets adjacent to the left main coronary artery, and to facilitate delivering and placing the percutaneous valve. 3 We hypothesized that the introduction of a TAVI program to a cardiac center would influence BAV procedural volumes and indications, not only through its use as an adjunctive step in TAVI, but also in evaluating the severity of aortic stenosis-offering an improvement in left ventricular (LV) dysfunction and thus potentially bridging inoperable patients to TAVI. The purpose of this study was to examine the changing volumes and indications for BAV in a tertiary referral center with a newly developed TAVI program, and to examine the outcomes of patients who had undergone BAV. Patients and MethodsUsing current procedural terminology (CPT) billing codes, we identified consecutive patients who had undergone BAV from January 2009 through December 2012 at our academic tertiary referral center. Comorbidity, clinical, hemodynamic, procedural, and follow-up data were obtained from reviews of hospital records. Data on deaths were obtained from Social Security Death Index records. Study approval was obtained from our institutional review board.

The Safety and Feasibility of Gastrointestinal Cancer Surgery with the Aid of Balloon Aortic Valvuloplasty in Patients with Severe Aortic Stenosis

“…However, BAV has not been a standard treatment because of its incomplete relief of obstruction and high restenosis rate [4,17] . In recent studies [18][19][20][21][22] , however, BAV has been reported to be acceptable in high-risk patients with AS (Table 5). BAV, as a preoperative therapy of noncardiac surgery, may be particularly beneficial for patients with severe AS because BAV can sufficiently improve hemodynamic status to lower the risk of noncardiac surgery [23] .…”

Valvuloplastia aórtica percutánea en la estenosis aórtica severa del adulto: indicaciones y morbimortalidad. Análisis del Registro de valvuloplastias aórticas de un centro cardiovascular universitario

“…Se definió VAP exitosa como la que alcanza una reducción de al menos 40% del gradiente pico a pico invasivo (GPPi) (10) , sin complicaciones mayores (definidas como muerte, bloqueo auriculoventricular completo, insuficiencia aórtica severa, accidente cerebrovascular). Definimos mortalidad asociada al procedimiento como aquella que se produce durante la realización de este o en las primeras 24 horas (14,15) .…”

Fabricating a Low-cost and Low-immune Xenogeneic Aortic Valve Bio Prosthesis

“…Some of the most common heart valvular diseases are aortic and mitral valve stenosis, calci cation of the valve lea ets due to aging [2], in ammation, and thrombosis of lea ets due to reactive oxygen species (ROS) [3]. The treatments available for valve stenosis and dysfunction are balloon valvuloplasty [4], failure of which leaves us with the sole option to replace the valve surgically. The usual preference for young patients is mechanical valves, whereas, for older age groups, the bioprosthetic valves are favored.…”