In-hospital morbid-mortality rates for balloon aortic valvuloplasty are similar to those for transcatheter aortic valve implantation

Courtesy of Dr. Carlos Fava.

The balloon aortic valvuloplasty (BAV) was introduced by Dr. Cribier in 1986. However, given its poor results, soon after it fell into disuse. With the introduction of TAVR, it saw a revival as bridge for another intervention, even though it is still resisted in many places.

The present study analyzed the outcomes of 3168 patients undergoing BAV between 2004 and 2013. It is worth mentioning that the number of BAV cases has significantly increased after the introduction and development of TAVR.

Patients were divided in “pre TAVR” (1294 patients – 40.8% of the sample) and “post TAVR” (1874 patients – 59.2% of the sample). Mean age was 82 (half were men) and most were treated in university centers (84%).

Procedural mortality was 1.4% and hospital mortality, 8.5%. Vascular complications appeared in 7.6% of cases; access site surgical repair was 2%, stroke was 1.8%, and 3% required definite pacemaker. In hospital stay was 8.5±9.2 days.

During the 10 years this analyzis was carried out, there were no significant differences in hospital mortality, stroke, or vascular complications.

Strong predictors of hospital death were the presence of cardiogenic shock, the need of left vascular assist, coagulopathies and elective BAV.

The most experienced centers (≥18 BAV/year) presented lower hospital mortality.

Propensity score matching was done on post TAVR patients, which resulted in 515 patients in each group. There were no significant differences as regards procedural success, vascular complications and stroke. Those undergoing BAV needed less definite pacemakers and transfusions. Hospitalization was prolonged in the post TAVR group. In addition, there were more comorbidities in the post TAVR group.

Conclusion

In this contemporary national registry, in-hospital complications for balloon aortic valvuloplasty were similar to those for TAVI as regards mobidity and mortality. With a substantial increase in BAV and better TAVR outcomes, these data have important implications to help select the suitable BAV candidates. 

Commentary

BAV has been advancing across the world together with the growth of life expectancy and the higher presence of aortic stenosis.

This analyzis shows this procedure is feasible and safe, and has comparable outcomes to TAVR (especially in high volume centers). On the other hand, we should consider this procedure in cases where immediate percutaneous valve implantation is not possible, or in low functional class cases, or in patients presenting cardiac failure. The development of new, better closure devices will most likely reduce vascular complications.

Courtesy of Dr. Carlos Fava.

Original title: Morbidity and Mortality Associated With Ballon Aortic Valvuloplasty. A National Perpective

Reference: Mohamed Alkhouli, et al Circ Cardiovasc Interv 2017;10:e004481

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