Page 26 - Journal of Structural Heart Disease - Volume 1 Issue 1

Original Research Article
Journal of Structural Heart Disease, May 2015, Volume 1, Issue 1: 20-32
DOI: http://dx.doi.org/10.12945/j.jshd.2015.00009-14
Balloon Aortic Valvuloplasty
Patient Selection and Technical Considerations
Received: December 8, 2014 Accepted: December 15, 2014 Published online: May 2015
Ted Feldman, MD, FESC, FACC, MSCAI*, Mohammad Sarraf, MD, Wes Pedersen, MD, FACC, FSCAI Evanston Hospital, NorthShore University Health System, Evanston, Illinois
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Abstract
BAV has had resurgence in association with the dissem- ination of TAVR. The lack of clear mortality benefit from BAV does not translate to lack of efficacy as a palliative therapy. BAV remains a useful bridge to surgical AVR or TAVR, and for symptom relief in patients who are not candidates for either AVR approach. It is also useful as a diagnostic test for patients with low gradient-low out- put AS, and for those with mixed pulmonary and aortic valvular disease. BAV is used commonly for TAVR pre dilatation, and this is sometimes helpful for annulus size assessment. Careful attention to balloon diameter selection and the details of technique are important for optimizing outcomes.
Copyright © 2015 Science International Corp.
Key Words
Balloon • Aortic • Valvuloplasty • General
Introduction
It is widely recognized that balloon aortic valvu- loplasty balloon aortic valvuloplasty (BAV) does not contribute to an improvement in survival among nonsurgical or very high-risk patients with aortic ste- nosis. Unfortunately, the value of BAV as a palliative therapy has been overlooked in the shadow of this lack of mortality benefit. Clinical improvement after
BAV occurs in the vast majority of patients. While in many this clinical improvement is short-lived, a ma- jority of patients feel improved symptoms for as long as 1 year [1]. The utility of this therapy as a palliative treatment is seen best among patients, who truly have no other option [2]. For example, the extreme risk patient, who is a candidate for neither surgical nor transcatheter AVR may undergo BAV periodically for relief of symptoms. In our practice, there are pa- tients, who have had roughly once yearly BAV proce- dures over a period of 2 or 3 years. This was, of course, more common before the availability of TAVR.
Indications for Balloon Aortic Valvulolasty (BAV)
Contemporary indications for balloon aortic val- vuloplasty (BAV) in adults are framed by the use of transcatheter aortic valve replacement (TAVR) as the mainstay of therapy for patients with aortic steno- sis (AS) who are high risk for surgical valve replace- ment (SAVR) [3]. BAV has clinical utility in several cir- cumstances in current practice. The 2014 AHA/ ACC guideline for the management of patients with valvu- lar heart disease characterizes this in a single level IIb (level of evidence C) recommendation, stating, “Per- cutaneous aortic balloon dilation may be considered
* Corresponding Author:
Ted Feldman, MD, FESC FACC MSCAI
Cardiology Division
Evanston Hospital
Walgreen Building 3rd Floor, Evanston, Illinois 60201 USA
Tel: +1 847 570-2250, Fax: +1 847 570-1865, E-Mail: tfeldman@tfeldman.org
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2015 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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