Key result
Balloon aortic valvuloplasty carries ~52% 1-year mortality, but subsequent AVR is linked to improved survival.
Why the study?
Balloon aortic valvuloplasty is used in high-risk severe aortic stenosis patients when the benefit of TAVR or SAVR is unclear, necessitating identification of features predicting benefit.
Cohort (n=141)
In high-risk patients with severe aortic stenosis undergoing balloon aortic valvuloplasty, 1-year mortality is high (52%), but survival is significantly better in those with preserved LVEF, better global longitudinal strain, and those who subsequently undergo definitive valve replacement.
BACKGROUND: Balloon aortic valvuloplasty (BAV) is used in high-risk patients with severe aortic stenosis (AS) when the benefit of transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) is unclear. Our objective was to identify clinical or echocardiographic features that identify patients likely to benefit from BAV. METHODS: We studied 141 consecutive patients who underwent BAV from July, 2011 to October, 2017. Clinical characteristics, routine echocardiographic parameters, and speckle tracking imaging of global longitudinal strain (GLS) were assessed before and after BAV. The primary outcome was all-cause mortality as ascertained by the National Death Index. RESULTS: There were 141 patients, median age, 80 years (interquartile range [IQR], 74-87 years) with severe AS (median aortic valve area, 0.66 cm²; IQR, 0.53-0.79 cm²) and median mean gradient of 36 mm Hg (IQR, 27-48 mm Hg) who underwent BAV. The 1-year mortality rate was 52%. Characteristics associated with survival were New York Heart Association class I symptoms, lower brain natriuretic peptide level, higher left ventricular ejection fraction (LVEF) >53%, and higher GLS (>13.2%; absolute values were used for GLS). Landmark analysis at 60 days showed the 47 patients who underwent TAVR/SAVR after BAV had significantly better 1-year survival than those who did not (P<.001). CONCLUSION: A high 1-year mortality rate was observed in severe AS patients selected for BAV. LVEF and left ventricular (LV)-GLS offer similar prognostic value for 1-year mortality; however, LV-GLS may have potentially increased clinical utility, as it provides a clear threshold for predicting poor outcomes compared with LVEF. As patients who undergo TAVR/SAVR have markedly improved mortality, careful consideration should be given to advance definitive valve therapy in carefully selected BAV patients.
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Husaini et al. (2020) conducted a cohort in severe aortic stenosis (n=141). Balloon aortic valvuloplasty (BAV) was evaluated on all-cause mortality. Among patients with severe aortic stenosis undergoing balloon aortic valvuloplasty, the 1-year mortality rate was 52%, while subsequent TAVR or SAVR significantly improved survival (P<.001).
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