Immediate results and 12-month survival after balloon aortic valvuloplasty for critical aortic stenosis in end-stage heart failure patients at high risk of surgical aortic valve replacement

Aim of the study: The aim of the study was to assess immediate haemodynamic results and 12-month survival of patients with critical aortic valve stenosis, severe heart failure and high surgical risk, treated with balloon aortic valvuloplasty (BAV).

Material and methods: The prospective registry comprised the first consecutive BAV-treated patients with NYHA class IV and operative risk ≥ 20% according to the Logistic EuroSCORE, and patients disqualified from surgical treatment for any reason. Baseline and post-BAV values of aortic valve area (AVA), left ventricle ejection fraction (LVEF) and pulmonary hypertension (RVSP) were compared. The primary end-point was 12-month survival. BAV procedures were performed via femoral artery access, under local anaesthesia.

Results: The study group consisted of 15 patients (11 female), aged 78.3 ±5.9 years with a mean Log EuroSCORE = 27.0 ±9.56%. Six patients had cardiogenic shock. One procedure was complicated by acute coronary artery occlusion. The mean aortic valve area increased from 0.57 ±0.18 cm2 to 0.93 ±0.28 cm2 (P = 0.0008). Four patients underwent transcatheter aortic valve implantation (TAVI), three had surgical aortic valve replacement (AVR), two refused further treatment, whilst four were disqualified from TAVI and AVR. In two patients, the TAVI procedure was considered. The survival rate at 12 months was 53% (8 pts). Five out of the total of 7 deaths were in-hospital. Mortality was lower in patients treated with BAV followed by either TAVI or AVR (P log rank 0.07).

Conclusions: Patients with critical aortic valve stenosis in end-stage heart failure and high surgical risk can safely undergo BAV, which offers an immediate increase of aortic valve area. Thereafter, definitive treatment in the form of TAVI or AVR should be aimed for.