Page 37 - Journal of Structural Heart Disease - Volume 1 Issue 1

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Original Research Article
diminished likelihood of LV perforation.
Complications
BAV may cause clinically important complica- tions, mainly during the procedure that should be addressed immediately. The main complications in- clude death (2.5%), stroke (2%), vascular complica- tions (2.5%), severe aortic insufficiency (1.5%) and permanent pacemaker requirement (<1%) [13]. These risks should be carefully addressed to the patients prior to the procedures. Severe aortic insufficiency is more common with balloon oversizing. A strategy for the short term management of severe aortic insuffi- ciency is tachycardia pacing [14]. In the worst cases a permanent pacemaker can be implanted and used to keep the heart rate between 90–110 bpm to minimize the diastolic time. It is noteworthy that high volume operators may have a lower incidence of these com- plications. Also, the studies are somewhat heteroge- neous, and the risk of the patients may vary from one study to the other. For example, in one study the in- vestigators included patients with cardiogenic shock who underwent BAV, and the in-hospital mortality was 56%, but the overall risk of patients without car- diogenic shock was still 2% [15]. This emphasizes the underlying risk inherent in the patients that undergo BAV, and the importance of careful patient selection for the procedure.
References
1. Agarwal A, Kini AS, Attanti S, Lee PC, Ash- tiani R, Steinheimer AM, et al. Results of re- peat balloon valvuloplasty for treatment of aortic stenosis in patients aged 59 to 104 years. Am J Cardiol. 2005;95:43-47. DOI: 10.1016/j.amjcard.2004.08.061
2. Hara H, Pedersen WR, Ladich E, Mooney M, Virmani R, Nakamura M, et al. Percuta- neous balloon aortic valvuloplasty revis- ited: time for a renaissance? Circulation. 2007;115:e334-e338. DOI: 10.1161/CIRCU- LATIONAHA.106.657098
3. Pedersen WR, Goldenberg IF, Feldman T. BAV in the TAVI Era: A review of current technique; uses in stand alone, bridging and predilation settings. Card Interv Today. 2010;4(4):77-84. Retrieved from http://ci- today.com/2010/08/balloon-aortic-valvu- loplasty-in-the-tavi-era/
Conclusions
BAV has had resurgence in association with the dis- semination of TAVR. The lack of clear mortality benefit from BAV does not translate to lack of efficacy as a palliative therapy. BAV remains useful a bridge to sur- gical AVR or TAVR, and for symptom relief in patients who not candidates for either AVR approach. It is also useful as a diagnostic test for patients with low gra- dient-low output AS, and for those with mixed pul- monary and aortic valvular disease. BAV is used com- monly for TAVR predilatation, and this is sometimes helpful for annulus size assessment. Careful attention to balloon diameter selection and the details of tech- nique are important for optimizing outcomes.
Conflict of Interest
Dr Feldman is a consultant to Abbott, BSC, and Edwards. Dr Pedersen has ownership interest in InterValve.
Comment on this Article or Ask a Question
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Feldman, T. et al.
Balloon Aortic Valvuloplasty