Key result
Balloon aortic valvuloplasty significantly reduced the median days of heart failure hospitalization from 9 days prior to the procedure to 0 days post-procedure (p<0.001) in patients with severe aortic stenosis and limited life expectancy.
Why the study?
Whether balloon aortic valvuloplasty provides effective palliation in symptomatic high-risk patients with severe aortic stenosis is uncertain.
Does balloon aortic valvuloplasty (BAV) reduce heart failure hospitalization days in symptomatic high-risk patients with severe aortic stenosis and limited life expectancy?
Observational (n=132)
No
Does balloon aortic valvuloplasty (BAV) reduce heart failure hospitalization days in symptomatic high-risk patients with severe aortic stenosis and limited life expectancy?
Absolute Event Rate: 0% vs 9%
p-value: p=<0.001
Palliative balloon aortic valvuloplasty safely and significantly reduces heart failure hospitalizations in frail, elderly patients with severe aortic stenosis, though untreated concomitant coronary artery disease increases 1-year mortality.
Whether balloon aortic valvuloplasty (BAV) may provide an effective palliation in symptomatic high-risk patients is uncertain. Therefore, we aimed to evaluate outcomes in symptomatic high-risk patients with severe aortic stenosis (AS), who underwent BAV. All-cause mortality and length of hospitalization for heart failure (HF) up to death or to 1-year follow up were collected after BAV. One hundred thirty-two (132) patients (62% women), mean age 85±7 years, underwent BAV with a substantial reduction of the peak-to-peak aortic gradient from 53±21 to 29±15 mmHg (p<0.001). The median of days of HF hospitalization prior to BAV was 9 (0-19), and decreased after BAV to 0 (0-9), p<0.001. During 1-year follow-up patients with untreated CAD (85, 64%) had a higher mortality compared to patients with insignificant/treated CAD (47, 36%): 1-year survival: 45±7% vs. 66± 7%; p=0.02. After adjustment for STS risk score and severity of residual AS, patients with untreated CAD remained at higher risk of mortality (adjusted HR 1.74 [1.01-2.91]; p=0.04). Thus, in this series of symptomatic high-risk patients, BAV was associated with a significant reduction in aortic valve gradient and hospitalization time for HF post-BAV. In patients with significant CAD, percutaneous intervention might be considered in order to improve survival.
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Mantovani et al. (2020) conducted an observational in Severe aortic stenosis with limited life expectancy (n=132). Balloon aortic valvuloplasty (BAV) vs. Pre-BAV period (mirrored period) was evaluated on Change in the number of days of hospitalization for heart failure prior to and post-BAV (p=<0.001). Balloon aortic valvuloplasty significantly reduced the median days of heart failure hospitalization from 9 days prior to the procedure to 0 days post-procedure (p<0.001) in patients with severe aortic stenosis and limited life expectancy.
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