Randomized comparison of balloon aortic valvuloplasty performed with or without rapid cardiac pacing: The pacing versus no pacing (PNP) study

Dall’Ara, Gianni; Marzocchi, Antonío; Taglieri, Nevio; Moretti, Carolina; Rodinò, Giulio; Chiarabelli, Matteo; Bottoni, P; Marrozzini, Cinzia; Sabattini, Maria Rita; Reggiani, Maria Letizia Bacchi; Rapezzi, Claudio; Saia, Francesco

doi:10.1111/joic.12452

Cited by 12 publications

(11 citation statements)

References 19 publications

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“…Trend toward decrease of maximal trans-aortic gradients was noted. This is in clear contrast to observations from much healthier (Euroscore II 6% and LVEF > 50%) Italian cohort of 100 patients, where 50% reduction of the echocardiographic mean trans-valvular gradient was met in as high as 42.9% and 39.2% (depending from studied subgroups) patients after BAV [5]. Further, it remains a matter for further discussions, if such failure of trans-aortic gradient reduction in our cohort would explain high in-hospital mortality.…”

Section: Efficacy Of Bavcontrasting

confidence: 96%

“…Improvement of BAV efficacy: in majority of our cases we only used one short (ca 5 seconds) balloon inflation with balloon diameter calculated according to shorter native aortic annulus diameter measured in MSCT or in echocardiography, regardless of immediate post-BAV trans-aortic gradient. Dall'Ara G. et al presented different protocol, which consisted of a sequence of at least 3 balloon inflations [5]. Most of the authors just overlook this technical issue.…”

Section: Efficacy Of Bavmentioning

confidence: 99%

“…The morbidity and mortality associated with elective procedure is significant (in-hospital mortality 2-15%) [5]. There are almost no direct comparison data, but when compared with elective-BAV, an urgent procedure is associated with around 6-fold increase in mortality [6].…”

Section: Introductionmentioning

confidence: 99%

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Elective versus rescue balloon aortic valvuloplasty for critical aortic stenosis

et al. 2020

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Section: Efficacy Of Bavcontrasting

confidence: 96%

Section: Efficacy Of Bavmentioning

confidence: 99%

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Elective versus rescue balloon aortic valvuloplasty for critical aortic stenosis

et al. 2020

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“…However, fewer people in the no pacing group complained of poor tolerance to the procedure. Moreover, temporary PM implantation and the incidence of moderate/severe renal function worsening were less common in the no pacing group [18]. In a study by Witzke at al.…”

Section: Discussionmentioning

confidence: 90%

“…There is also a possibility of BAV without rapid pacing, which can be an even less invasive and better tolerated method with comparable acute outcomes [18,19]. Nonetheless, lack of any pacing may result in balloon instability during inflation unless using a dog-bone-shaped balloon requiring, however, a larger introductory sheath [20].…”

Section: Discussionmentioning

confidence: 99%

Direct Rapid Left Ventricular Wire Pacing during Balloon Aortic Valvuloplasty

Kleczyński

Dziewierz

Socha

et al. 2020

JCM

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Background: Rapid ventricular pacing is mandatory for optimal balloon positioning during aortic valvuloplasty (BAV) in patients with severe aortic stenosis. We aimed to assess the safety and efficacy of direct left ventricular (LV) guidewire pacing in comparison with regular pacing induced by temporary pacemaker (PM) placement in the right ventricle. Methods: Direct rapid LV pacing was provided with a 0.035″ guidewire. Baseline clinical characteristics, echocardiographic and procedural data, as well as complication rates, were compared between the two groups. Results: A total of 202 patients undergoing BAV were enrolled (49.5% with direct LV guidewire pacing). The pacing success rate was 100%. In the direct LV guidewire pacing group, we found a lower radiation dose, shorter fluoroscopy and overall procedural time (0.16 vs. 0.28 Gy, p = 0.02; 5.4 vs. 10.3 min, p = 0.01; 17 vs. 25 min, p = 0.01; respectively). In addition, the complication rate was lower in that group (cardiac tamponades, vascular access site complications, blood transfusions rate, and in-hospital mortality: 0% vs. 3.9%; 4.0% vs. 15.7%; 2.0% vs. 12.7%; 2.0% vs. 9.8%, p = 0.01 for all, respectively). Conclusions: Direct rapid LV guidewire pacing is a simple, safe and effective option for BAV with a reduced complication rate compared to a temporary PM placed in the right ventricle.

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Contemporary balloon aortic valvuloplasty: Changing indications and refined technique

Dall’Ara

Tumscitz²,

Grotti

et al. 2020

Cathet Cardio Intervent

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Even if un to improve long‐term prognosis, balloon aortic valvuloplasty (BAV) may be useful in selected patients with symptomatic severe aortic stenosis either as a bridge to surgical or transcatheter valve replacement (aortic valve replacement [AVR] or transcatheter aortic valve implantation [TAVI]) or as a triage strategy for patients with uncertain indications. International guidelines recommend BAV as: a “bridge” to AVR/TAVI, a “trial” in patients with undetermined symptoms, or a “bridge‐to‐decision” in case of comorbidities. However, in clinical practice, BAV is also used as a palliative measure to improve hemodynamics and quality of life in many patients who are excluded from AVR/TAVI. Finally, BAV is often performed during TAVI to facilitate prosthesis delivery, optimize frame expansion, or for bioprosthetic valve fracture in selected valve‐in‐valve procedures. Technical innovations, which allow for a mini‐invasive approach via transradial access and pacing delivered through the wire, have led to a decrease in complications over time. This review focuses on contemporary BAV with a specific emphasis on new indications, innovative techniques, and specific complex patient subgroups.

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Randomized comparison of balloon aortic valvuloplasty performed with or without rapid cardiac pacing: The pacing versus no pacing (PNP) study

Abstract: Rapid ventricular pacing did not influence BAV efficacy or safety and tolerance was slightly worse.

Cited by 12 publications

References 19 publications

Elective versus rescue balloon aortic valvuloplasty for critical aortic stenosis

Elective versus rescue balloon aortic valvuloplasty for critical aortic stenosis

Direct Rapid Left Ventricular Wire Pacing during Balloon Aortic Valvuloplasty

Contemporary balloon aortic valvuloplasty: Changing indications and refined technique

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