Key result
A systematic invasive strategy using preoperative balloon aortic valvuloplasty did not significantly reduce 1-month major adverse cardiac events compared to conservative management in patients with severe aortic stenosis undergoing urgent non-cardiac surgery (20.4% vs 20.0%; OR 0.93).
Why the study?
Whether preoperative balloon aortic valvuloplasty is better than medical therapy in patients with severe aortic stenosis requiring urgent non-cardiac surgery is unknown.
Does preoperative balloon aortic valvuloplasty reduce MACE in patients with severe aortic stenosis undergoing urgent non-cardiac surgery?
Cohort (n=133)
Yes
Does preoperative balloon aortic valvuloplasty reduce MACE in patients with severe aortic stenosis undergoing urgent non-cardiac surgery?
Routine preoperative balloon aortic valvuloplasty does not improve short-term clinical outcomes compared to conservative management in patients with severe aortic stenosis requiring urgent non-cardiac surgery.
BAV before urgent NCS showed no outcome benefit over conservative care; leaves open selective use in high-risk subsets pending prospective trials.
BACKGROUND: Balloon aortic valvuloplasty (BAV) has been proposed as a therapeutic option in patients suffering from severe aortic stenosis (SAS) who need urgent non-cardiac surgery (NCS). Whether this strategy is better than medical therapy in this very specific population is unknown. AIMS: We aimed to evaluate the clinical benefit of an invasive strategy (IS) with preoperative BAV in patients with SAS requiring urgent NCS. METHODS: From 2011 to 2019, a registry conducted in two centres included 133 patients with SAS undergoing urgent NCS, of whom 93 underwent preoperative BAV (IS) and 40 a conservative strategy (CS) without BAV. All analyses were adjusted for confounding using inverse probability of treatment weighting (IPTW) (10 clinical and anatomical variables). RESULTS: The primary outcome was MACE at one-month follow-up after NCS including mortality, heart failure, and other cardiovascular outcomes. In patients managed conservatively, occurrence of MACE was 20.0% (n=8) and death was 10.0% (n=4) at 1 month. In patients undergoing BAV, the occurrence of MACE was 20.4% (n=19) and death was 5.4% (n=5) at 1 month. Among patients undergoing conservative management, all events were observed after NCS while, in patients undergoing BAV, 12.9% (n=12) had events between BAV and NCS including 3 deaths, and 7.5% (n=7) had events after NCS including 2 deaths. In IPTW propensity analyses, the incidence of the primary outcome (20.4% vs 20.0%; OR 0.93, 95% CI: 0.38-2.29) and three-month survival (89.2% vs 90.0%; IPTW-adjusted HR 0.90, 95% CI: 0.31-2.60) were similar in both groups. CONCLUSIONS: Patients with SAS managed conservatively before urgent NCS are at high risk of events. A systematic invasive strategy using BAV does not provide a significant improvement in clinical outcome.
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Debry et al. (2021) conducted a cohort in Severe aortic stenosis requiring urgent non-cardiac surgery (n=133). Preoperative balloon aortic valvuloplasty (BAV) vs. Conservative strategy (no BAV) was evaluated on Major adverse cardiac events (MACE) at 1 month after non-cardiac surgery (OR 0.93, 95% CI 0.38-2.29, p=0.88). A systematic invasive strategy using preoperative balloon aortic valvuloplasty did not significantly reduce 1-month major adverse cardiac events compared to conservative management in patients with severe aortic stenosis undergoing urgent non-cardiac surgery (20.4% vs 20.0%; OR 0.93).
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