Muhammed Z Khawaja, Manav Sohal,
Haseeb Valli,
Rafal Dworakowski,
Stephen J Pettit,
David Roy,
James Newton,
Heiko Schneider,
Ganesh Manoharan,
Sagar Doshi, [......],
Vaikom S Mahadevan,
Stephen J Brecker,
Philip Maccarthy Phd,
Michael Mullen,
Rodney H Stables Dm,
Bernard D Prendergast Dm,
Adam de Belder,
Martyn Thomas,
Simon Redwood,
David Hildick-Smith
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ABSTRACT: OBJECTIVES: We sought to characterize UK-wide balloon aortic valvuloplasty (BAV) experience in the TAVI era. BACKGROUND: BAV for acquired calcific aortic stenosis is in a phase of renaissance, largely due to the development of transcatheter aortic valve implantation (TAVI). METHODS: Data from 423 patients at 14 centres across the UK were analysed. RESULTS: Patients were aged 80.9±9.5 years; 52.5% were male. Mean logistic EuroScore was 27.3±16.8%. Mean peak transaortic gradient fell from 62.0±26.3 to 28.3±16.2 mmHg. Aortic valve area increased from 0.58±0.19 to 0.80±0.25cm(2) echocardiographically. Procedural complication rate was 6.3%, comprising death (2.4%), blood transfusion ≥2 units (1.2%), cardiac tamponade (1.0%), stroke (1.0%), vascular surgical repair (1.0%), coronary embolism (0.5%) and permanent pacemaker (0.2%). Mortality was 13.8% at 30-days and 36.3% at 12 months. Subsequently, 18.3% of patients underwent TAVI and 7.0% sAVR, with improved survival compared to those who had no further intervention (logrank <0.0001). Multivariate Cox proportional hazard analysis demonstrated that survival was adversely effected by the presence of coronary artery disease (HR1.53, 95%CI1.08-2.17, p=0.018), poor LV function (HR1.54, 95%CI1.09-2.16, p=0.014), and either urgent (HR1.70, 95%CI1.18-2.45; p=0.004) or emergent presentation (HR3.72, 95%CI2.27-6.08; p<0.0001). CONCLUSION: Balloon aortic valvuloplasty offers good immediate haemodynamic efficacy at an acceptable risk of major complications. Medium term prognosis is poor in the absence of definitive therapy. © 2012 Wiley Periodicals, Inc.
Catheterization and Cardiovascular Interventions 06/2012; · 2.29 Impact Factor
