Doing a balloon aortic valvuloplasty can be a good way to “buy” time before a transcatheter aortic valve replacement (TAVR), according to a registry to be published this week in J Am Coll Cardiol Intv.
This study analyzed the database of a whole country to find out the incidence, predictors and outcomes of balloon aortic valvuloplasty as a bridge to TAVR in the daily clinical practice.
Of 3691 patients receiving balloon aortic valvuloplasty between 2015 and 2016, 1426 subsequently received TAVR. TAVR was prior discharge in 7.4%, within 30 days in 35%, between 31 and 90 days in 47%, between 91 and 180 days in 14%, and over 180 days in 4% of patients.
Negative predictors of valvuloplasty patients reaching TAVR (before or after) resulted quite logical and expected. A history of defibrillation, dementia, malnutrition, and severe comorbidities predicted patients would not get to TAVR.
When comparing patients with direct access to TAVR vs. balloon valvuloplasty patients, they found inhospital mortality was practically identical (3.7% vs 3.5% after propensity score matching; p=0.91).
Major complications, hospital-stay and discharge conditions also resulted similar, even though costs increased for those who went directly to TAVR.
Conclusion
In this contemporary registry of the daily practice, up to 40% of patients with severe aortic stenosis received balloon aortic valvuloplasty as bridge to TAVR. Most of them within 90 days.
Outcomes between those undergoing TAVR directly and those with prior valvuloplasty were similar, which makes it adequate to “buy” time before the end goal.
Original Title: Balloon Aortic Valvuloplasty as a Bridge to Aortic Valve Replacement A Contemporary Nationwide Perspective.
Reference: Akram Kawsara et al. J Am Coll Cardiol Intv 2020, article in press.
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