Does retrograde transfemoral BAV with a low-profile, compliant balloon improve hemodynamics and safety in high-risk patients with severe aortic stenosis?
Transfemoral balloon aortic valvuloplasty using a low-profile compliant balloon is feasible, safe, and immediately effective in improving hemodynamics in high-risk patients with severe aortic stenosis.
OBJECTIVES: To determine the safety and immediate efficacy after balloon aortic valvuloplasty (BAV) with a new, low-profile balloon. BACKGROUND: BAV has a continuing role in the management of high-risk patients with severe aortic stenosis (AS). BAV with traditional noncompliant balloons requires a large femoral arteriotomy and is associated with high rates of access site complications. METHODS: We retrospectively reviewed medical records of 20 consecutive patients undergoing BAV for severe AS. Retrograde transfemoral BAV was performed with a low-profile, compliant valvuloplasty balloon. Before and after BAV, transaortic gradients were measured invasively and by echocardiography, and aortic valve area (AVA) calculated. Access site complications, functional class and survival were recorded. RESULTS: Patients were 79 +/- 12 years old and had an estimated mortality from open aortic valve replacement of (12.5 +/- 9.6)%. By catheterization, mean aortic gradient fell from 44 +/- 15 to 29 +/- 10 mm Hg (P < 0.001) and AVA increased from 0.63 +/- 0.22 to 0.89 +/- 0.33 cm(2) (P < 0.001). New York Heart Association functional class improved from 3.5 +/- 0.7 to 2.7 +/- 0.8. Procedural mortality was 0%. There were no vascular complications or significant worsening of aortic regurgitation. CONCLUSION: Transfemoral BAV using a low-profile compliant balloon is feasible with acceptable immediate results and safety.
Yamen et al. (Tue,) studied this question.