Page 27 - Journal of Structural Heart Disease - Volume 1 Issue 1

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Original Research Article
Figure 1. Hand injection of contrast during BAV with a 22mm balloon showed locking of the balloon and no contrast regurgi- tation around the balloon.
as a bridge to surgical AVR or TAVR in patients with severe symptomatic AS” [4,5]. This defines an import- ant role for BAV among patients who are unstable or in refractory heart failure prior to valve replacement with either SAVR or TAVR [6]. These patients may pres- ent with refractory heart failure or shock, and BAV can
Table 1. Indications for BAV
Bridge to SAVR
• Stabilize shock
• Treat severe CHF • Bridge to TAVI
Symptom relief
• Stabilization while evaluation is undertaken
Diagnostic test: see how patient responds • Low gradient/low output patient
• Mixed lung and valve disease
Therapy for “no-option” patient
• Anyone can undergo AVR
• Apical-descending aorta conduit is an option for some
Pre-op for non-cardiac surgery
Predilatation • Sizing
Figure 1 Video.
make them more manageable for the short term. BAV is also used in several other clinical situations (Table 1). Another important utility of BAV is as a di- agnostic test. Patients with low gradient and low output aortic stenosis with low left ventricular ejec- tion fraction represent a frequent diagnostic conun- drum. Prior to aortic valve replacement, BAV in this population may unmask the myocardial reserver for a more invasive valve replacement therapy. The best example of this patient group is those with mixed chronic lung and valvular heart disease. The degree to which they may improve after valve therapy is often uncertain, and those who have a favorable response to BAV may be expected to similarly benefit from
aortic valve replacement.
A more controversial use of BAV is prior to non-car-
diac surgery. While many patients with severe aortic stenosis can undergo non-cardiac surgery when spe- cial care is taken to manage their hemodynamic situ- ation, there are clearly patients, who have no reserve for whom management during non-cardiac surgery is challenging. The patient, who presents with an absolute aortic valve area less than 0.5 cm2, or those with low cardiac output, very high pulmonary or pul-
Feldman, T. et al.
Balloon Aortic Valvuloplasty