B-62 | Aortic valvuloplasty: double-balloon technique through bilateral radial access

Balloon aortic valvuloplasty (BAV) is a versatile procedure but it requires a low rate of vascular complications to keep its place in the aortic stenosis (AS) toolbox. Radial access (RA) is a great alternative, but it has inherent limitations of sheath size. Unilateral RA BAV is proposed but it requires 8-10 Fr sheath and only compliant balloons can be used. We aim to establish the safety and technical success of bilateral RA BAV using a two-balloons technique. We treated 5 cases of severe calcified symptomatic AS in which the use of compliant balloons would have been inappropriate: 4 patients with lack of femoral access, one case of severe coagulopathy with no time for complete hemostatic compensation. Patients were treated on urgent basis: 3 in shock related to STEMI/NSTEMI plus severe AS; 2 with refractory cardiac failure and low flow, low gradient AS and poor ventricular function. Two women. Age 87 (68-92) years. We analyzed success (no femoral cross-over; gradient reduction >50% with no relevant aortic insufficiency; no stroke, MI, or death), vascular complications, radial patency, in-hospital major adverse events and 6-month clinical follow up. Procedure: BAV through bilateral RA, with simultaneous insufflation of two peripheral non-compliant balloons: 1. 6 French bilateral RA. 2. Two successive valve crossings, one from the right and the other from the left arm, with a 0.035" straight wire supported by an AL angiographic catheter, for deploying 2 pre-shaped TAVI 0.035" guidewires into the left ventricle. 3. Sheath changes according to balloons required. Relation of summatory of balloons diameters / annulus= 1. 4. Simultaneous insufflation at the level of the aortic valve of 2 peripheral non-compliant balloons deployed "bare on the wire". Four radial-radial and 1 radial-cubital access. Technical success in all patients. Simultaneous PCI in 4 cases. No vascular complications. We lose radial pulse in 1/9 RA, patent cubital access. Clinical improvement in all cases, no in-hospital deaths. Six months follow-up: 4 patients received definitive therapy (3 AVR and 1 TAVI) and one remained untreated and stable In this small series of patients, BAV with a two-balloon technique through bilateral RA was safe and effective.