Details

Autor(en) / Beteiligte

• Rigatelli, Gianluca
• Dell'Avvocata, Fabio
• Conte, Luca
• Lanza, Daniela
• Giatti, Sara
• Del Santo, Pierluigi
• Roncon, Loris
• Faggian, Giuseppe

Titel

Modified balloon aortic valvuloplasty in fragile symptomatic patients unsuitable for both surgical and percutaneous valve replacement

Ist Teil von

• Cardiovascular revascularization medicine, 2018-06, Vol.19 (4), p.444-447

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2018

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Balloon Aortic valvuloplasty (BAV) is considered as a bridge therapy to percutaneous valve implantation or a palliative treatment in patients with aortic valve stenosis (AVS). Potential risk of complications, in particular in fragile patients, is still not negligible. To describe the technique and outcomes of modified BAV in fragile symptomatic patients unsuitable for other treatments using no-pacing and minimally invasive approach. Symptomatic fragile patients with severe aortic valve stenosis judged unsuitable by the heart team for surgical or percutaneous valve implantation from 1 September 2013 to 1 September 2017 were offered modified BAV. Simplified procedural protocol included a 4F right radial artery access for gradient check, a 8F compatible undersized balloons, two partial inflations-trial before a full inflation with no-pace maker back-up, final pressure gradient recording and aortography. Thirty-four symptomatic fragile patients (mean age 80.9±4.9, range 73 to 91years, 100% Katz >6, mean Euroscore I 30.0±11.7%) underwent modified BAV in the last 5years with immediate success in all (100%). Mean aortic valve area increased from 0.58±0.2cm2 to 1.1±0.2cm2 (p<0.01) whereas mean peak gradient decreased from 75.6±11.3 to 35.8±11.2mmHg (p<0.01). Procedural complications were 14.7%. Thirty-day mortality was 11.8%. On a mean follow up of 38.4±4.6months four patients successfully repeated the procedure, while global mortality was 23.5% (8 patients). The other 22 patients maintained a NYHA class of 2.1±0.7. No-pacing minimally invasive BAV seems to have acceptable outcomes in patients with severe AVS and no other treatment options. •Potential risk of complications of balloon aortic valvuloplasty (BAV) as only therapy in patients with no other option in fragile patients is still high.•We describe a modified minimal invasive no-pacing and undersized balloon technique to perform BAV in fragile patients•In 34 patients modified BAV resulted in significant increase of aortic valve area and decrease of mean peak gradient with global procedural complications of 14.7% and 30-days mortality of 11.8%. On a mean follow up of 38.4±4.6 months global mortality was 23.5%.