Elective Versus Rescue Balloon Aortic Valvuloplasty For Critical Aortic Stenosis

BACKGROUND Balloon aortic valvuloplasty (BAV) may be considered a bridge to further intervention in hemodynamically unstable patients or patients with symptomatic severe aortic stenosis (AS).AIMS This study aimed to retrospectively compare periprocedural and in-hospital outcomes of AS patients treated with elective BAV (group 1) and rescue BAV (group 2).METHODS We identified 35 patients in whom BAV was performed between 2010 and 2018. Among them, 16 were treated electively (group 1) and 19 urgently (group 2).RESULTS Overall, BAV resulted in a significant decrease in the mean transaortic gradient by a median (interquartile range [IQR]) value of 5 (1-10) mm Hg (P <0.01) and the maximal transaortic gradient by a median (IQR) value of 13.5 (2.5-23.2) mm Hg (P <0.01). Postprocedural grade II aortic regurgitation rates increased from 8.6% to 17.1% (P= 0.48). Periprocedural death occurred in 4 patients (11.4%)-all from group 2 (21%) (P= 0.1). In-hospital death occurred in 15 patients (42.8%)-3 patients (18.7%) from group 1 and 12 patients (63.1%) from group 2 (P <0.01). During follow-up, a single patient underwent surgical aortic valve replacement, and transcatheter aortic valve implantation was performed in 4 individuals. A single patient died 22 months after BAV.CONCLUSIONS Periprocedural and in-hospital mortality in patientswith critical AS treated with BAV remains very high, especially in patients treated urgently.