Safety, efficacy and impact on frailty of mini-invasive radial balloon aortic valvuloplasty

Abstract

ObjectiveThe study was designed to: (1) confirm safety and feasibility of mini-invasive radial balloon aortic valvuloplasty (BAV); (2) assess its impact in terms of quality of life and frailty; and (3) evaluate whether changes in frailty after BAV are associated with death in patients undergoing transcatheter aortic valve implantation (TAVI).Methods330 patients undergoing BAV in 16 Italian centres were prospectively included. The primary endpoint was the occurrence of major and minor Valve Academic Research Consortium (VARC)-2 bleeding. Secondary endpoints were scales of quality of life, frailty, evaluated at baseline and 30 days, and their relationship with the occurrence of all-cause death.ResultsBAV was performed by radial access in 314 (95%) patients. No VARC-2 major and six (1.8%) VARC-2 minor bleedings occurred in the study population. Quality of life, as well as frailty status, significantly improved 30 days after BAV. At 1 year, patients undergoing TAVI with baseline essential frailty toolset (EFT) <3 or achieving an EFT <3 after BAV had a comparable occurrence of all-cause death (15% vs 19%, p=0.58). On the contrary, patients with EFT ≥3 at 30 days despite BAV showed the worst prognosis (all-cause death: 40% vs 15% and 19%, p=0.006 and p=0.05, respectively).ConclusionsMini-invasive radial BAV is safe, feasible and associated with a low rate of vascular complications. Patients improving EFT 30 days after BAV showed a favourable outcome after TAVI.Trial registration numberNCT03087552.

Balloon Aortic Valvuloplasty for Severe Aortic Stenosis as Rescue or Bridge Therapy

“…Our observations are in line with data shown in other studies showing reprise of BAV in the era of TAVI [3,4,8,9,[11][12][13]15,16,20,22]. When BAV is used as a bridge, it gives some time and opportunity to improve the clinical and hemodynamic response among treated patients with severe AS not being appropriate candidates for final treatment at that time point.…”

“…On the other hand, these rates were lower than reported for TAVI [18]. In the case of peripheral artery disease affecting both iliac arteries, transradial or transbrachial access is possible with the use of one or two balloons [19,20]. Periprocedural deaths were, in fact, limited to patients with hemodynamic instability/cardiogenic shock before the procedure.…”

Digital health in older adults for the prevention and management of cardiovascular diseases and frailty. A clinical consensus statement from the ESC Council for Cardiology Practice/Taskforce on Geriatric Cardiology, the ESC Digital Health Committee and the ESC Working Group on e‐Cardiology

“…One example is the Frailty Tool mApp (frailtytool.com) that integrates the Essential Frailty Toolset (EFT) alongside the Society of Thoracic Surgeons risk score to guide decision making in older adults referred for transcatheter aortic valve replacement (TAVR) or cardiac surgery. In addition to prognostic value, 88,89 therapeutic value has been demonstrated by de‐frailing patients with high EFT score using prehabilitation and multicomponent geriatric intervention 90,91 …”

“…In addition to prognostic value, 88,89 therapeutic value has been demonstrated by de-frailing patients with high EFT score using prehabilitation and multicomponent geriatric intervention. 90,91 In daily clinical practice, general cardiologists are increasingly using DH tools for the management of deficits associated with older-age (Figure 2). The progression of health decline and frailty may be usefully opposed by DH-supported management of medication adherence, physical and nutritional needs, and the specific requirements after acute events.…”

“…In addition to prognostic value, 88 , 89 therapeutic value has been demonstrated by de‐frailing patients with high EFT score using prehabilitation and multicomponent geriatric intervention. 90 , 91 …”