Balloon Aortic Valvuloplasty – Remaining Indications in the Modern TAVR Era

ObjectivesA retrospective observational cohort study to report on contemporary indications of balloon aortic valvuloplasty (BAV).BackgroundAs indications for transcatheter aortic valve replacement (TAVR) are increasing, BAV is reinforced as a bridging therapy.MethodsA total of 47 consecutive patients who underwent BAV in parallel to an existing TAVR program was retrospectively assessed for BAV indications and clinical events during 1 year of follow-up.ResultsThe following indications were distinguished: bridge to destination aortic valve replacement therapy (BTD), bridge to urgent non-cardiac therapy (BTN) or palliation. BAV was performed in 20 (43%) patients as BTD, in 18 (38%) as BTN and in 9 (19%) as palliative treatment. Patients in the BTN cohort were younger (age 74.1 ± 8.3% vs. 80.7 ± 8.3% years in BTD, p = 0.02) with lower STS-scores (2.2% [IQR 1.3–4.6] vs. 13.0% [IQR 7.6–22.2] p < 0.001). Overall baseline mean transaortic gradient was 43.2 mmHg and reduced by a mean of 16.0 ± 10.1 mmHg after BAV (p < 0.001). Procedural mortality was 8.5% (n = 4). All-cause mortality at 30 days and 1 year was 20% and 45% in BTD, 6% and 39% in BTN and 44% and 67% in the palliative group. Aortic valve replacement (AVR) was performed in 55% of the BTD and 50% of the BTN group at 1 year. Reasons for not undergoing definite AVR were clinical deterioration in BTD and terminal comorbidity in BTN. Compared to a contemporary TAVR cohort, procedural and 1 year mortality was significantly increased in the BAV cohort.ConclusionBAV remains a valuable option in well-defined patient phenotypes to determine AVR feasibility, bridge to urgent non-cardiac therapy, and at times, palliation. These phenotypes represent vulnerable patients with overall poor clinical outcome.