Safety and Efficacy of Balloon Aortic Valvuloplasty Stratified by Acuity of Patient Illness

Background Balloon aortic valvuloplasty (BAV) is often performed for patients with aortic stenosis who are not candidates for transcatheter aortic valve replacement (TAVR) due to concomitant medical issues. However, little is known about BAV outcomes stratified by acuity of illness. We sought to compare the safety and efficacy of BAV across a range of patient presentations including critical illness in an intensive care unit (ICU), heart failure hospitalization in a non-ICU ward, and the outpatient setting.Methods We assessed patients with aortic stenosis treated with BAV from 1/1/2012-7/31/2019. We compared procedural characteristics and outcomes, including hemodynamics, mortality, and whether patients underwent TAVR, stratified by acuity of presentation (ICU, ward, and outpatient).Results 612 patients underwent BAV; 111 (18.1%) were in the ICU, 297 (48.5%) were in the ward, 204 (33.3%) were outpatients. All ICU patients had cardiogenic or septic shock. Procedural and hemodynamic outcomes were similar across groups; invasive peak-to-peak aortic valve gradient improved in all patients (40 ± 21 to 18 ± 11 mmHg; p < 0.001) and complication rates were low (procedural mortality 0.5%). Most ICU patients clinically improved after BAV and survived to hospital discharge (80.2%). While ICU patients had higher 30-day mortality than ward and outpatients (31.5%, 5.4%, 3.4%; p < 0.001, respectively), among patients ultimately treated with TAVR there were no differences in long-term mortality (p = 0.74).Conclusion BAV is safe and effective at temporarily improving aortic valve function in patients with aortic stenosis across the spectrum of acuity of illness. Among critically ill patients with cardiogenic shock, BAV may facilitate recovery to discharge and serve as a bridge to TAVR.Abbreviations BAV: Balloon aortic valvuloplasty; AS: Aortic stenosis; TAVR: Transcatheter aortic valve replacement; ICU: Intensive care uni