Standalone balloon aortic valvuloplasty: Indications and outcomes from the UK in the transcatheter valve era

Muhammed Z. Khawaja; Manav Sohal; Haseeb Valli; Rafal Dworakowski; Stephen J. Pettit; David Roy; James Newton; Heiko Schneider; Ganesh Manoharan; Sagar Doshi; Douglas Muir; David Roberts; James Nolan; Mark Gunning; Cameron Densem; Mark S. Spence; Saqib Chowdhary; Vaikom S. Mahadevan; Stephen J. Brecker; Philip MacCarthy; Michael Mullen; Rodney H. Stables; Bernard D. Prendergast; Adam de Belder; Martyn Thomas; Simon Redwood; David Hildick-Smith

doi:10.1002/ccd.24534

Standalone balloon aortic valvuloplasty: Indications and outcomes from the UK in the transcatheter valve era

Muhammed Z. Khawaja, Manav Sohal, Haseeb Valli, Rafal Dworakowski, Stephen J. Pettit, David Roy, James Newton, Heiko Schneider, Ganesh Manoharan, Sagar Doshi, Douglas Muir, David Roberts, James Nolan, Mark Gunning, Cameron Densem, Mark S. Spence, Saqib Chowdhary, Vaikom S. Mahadevan, Stephen J. Brecker, Philip MacCarthyMichael Mullen, Rodney H. Stables, Bernard D. Prendergast, Adam de Belder, Martyn Thomas, Simon Redwood, David Hildick-Smith^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

70 Citations (Scopus)

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 centers across the UK were analyzed.

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 mm Hg. Aortic valve area increased from 0.58 +/- 0.19 to 0.80 +/- 0.25 cm2 echocardiographically. Procedural complication rate was 6.3%, comprising death (2.4%), blood transfusion 2 U (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 (HR 1.53, 95%CI 1.082.17, P = 0.018), poor LV function (HR 1.54, 95%CI 1.092.16, P = 0.014), and either urgent (HR 1.70, 95%CI 1.182.45; P = 0.004) or emergent presentation (HR 3.72, 95%CI 2.276.08; P <0.0001).

Conclusion
Balloon aortic valvuloplasty offers good immediate hemodynamic efficacy at an acceptable risk of major complications. Medium-term prognosis is poor in the absence of definitive therapy.

Original language	English
Pages (from-to)	366-373
Number of pages	8
Journal	CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS
Volume	81
Issue number	2
DOIs	https://doi.org/10.1002/ccd.24534
Publication status	Published - Feb 2013

Keywords

aortic stenosis
balloon aortic valvuloplasty
PERCUTANEOUS CORONARY INTERVENTION
LONG-TERM SURVIVAL
ELDERLY PATIENTS
HIGH-RISK
ARTERY-DISEASE
BONE-FORMATION
FOLLOW-UP
STENOSIS
IMPLANTATION
REGISTRY

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10.1002/ccd.24534

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Khawaja, M. Z., Sohal, M., Valli, H., Dworakowski, R., Pettit, S. J., Roy, D., Newton, J., Schneider, H., Manoharan, G., Doshi, S., Muir, D., Roberts, D., Nolan, J., Gunning, M., Densem, C., Spence, M. S., Chowdhary, S., Mahadevan, V. S., Brecker, S. J., ... Hildick-Smith, D. (2013). Standalone balloon aortic valvuloplasty: Indications and outcomes from the UK in the transcatheter valve era. CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 81(2), 366-373. https://doi.org/10.1002/ccd.24534

@article{5aa6c56a1ade4e9a8b7091d9bfe3ba89,

title = "Standalone balloon aortic valvuloplasty: Indications and outcomes from the UK in the transcatheter valve era",

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 centers across the UK were analyzed. 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 mm Hg. Aortic valve area increased from 0.58 +/- 0.19 to 0.80 +/- 0.25 cm2 echocardiographically. Procedural complication rate was 6.3%, comprising death (2.4%), blood transfusion 2 U (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 (HR 1.53, 95%CI 1.082.17, P = 0.018), poor LV function (HR 1.54, 95%CI 1.092.16, P = 0.014), and either urgent (HR 1.70, 95%CI 1.182.45; P = 0.004) or emergent presentation (HR 3.72, 95%CI 2.276.08; P <0.0001). Conclusion Balloon aortic valvuloplasty offers good immediate hemodynamic efficacy at an acceptable risk of major complications. Medium-term prognosis is poor in the absence of definitive therapy.",

keywords = "aortic stenosis, balloon aortic valvuloplasty, PERCUTANEOUS CORONARY INTERVENTION, LONG-TERM SURVIVAL, ELDERLY PATIENTS, HIGH-RISK, ARTERY-DISEASE, BONE-FORMATION, FOLLOW-UP, STENOSIS, IMPLANTATION, REGISTRY",

author = "Khawaja, {Muhammed Z.} and Manav Sohal and Haseeb Valli and Rafal Dworakowski and Pettit, {Stephen J.} and David Roy and James Newton and Heiko Schneider and Ganesh Manoharan and Sagar Doshi and Douglas Muir and David Roberts and James Nolan and Mark Gunning and Cameron Densem and Spence, {Mark S.} and Saqib Chowdhary and Mahadevan, {Vaikom S.} and Brecker, {Stephen J.} and Philip MacCarthy and Michael Mullen and Stables, {Rodney H.} and Prendergast, {Bernard D.} and {de Belder}, Adam and Martyn Thomas and Simon Redwood and David Hildick-Smith",

year = "2013",

month = feb,

doi = "10.1002/ccd.24534",

language = "English",

volume = "81",

pages = "366--373",

journal = "CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS",

issn = "1522-1946",

publisher = "Wiley-Liss Inc.",

number = "2",

}

Khawaja, MZ, Sohal, M, Valli, H, Dworakowski, R, Pettit, SJ, Roy, D, Newton, J, Schneider, H, Manoharan, G, Doshi, S, Muir, D, Roberts, D, Nolan, J, Gunning, M, Densem, C, Spence, MS, Chowdhary, S, Mahadevan, VS, Brecker, SJ, MacCarthy, P, Mullen, M, Stables, RH, Prendergast, BD, de Belder, A, Thomas, M , Redwood, S & Hildick-Smith, D 2013, 'Standalone balloon aortic valvuloplasty: Indications and outcomes from the UK in the transcatheter valve era', CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, vol. 81, no. 2, pp. 366-373. https://doi.org/10.1002/ccd.24534

TY - JOUR

T1 - Standalone balloon aortic valvuloplasty

T2 - Indications and outcomes from the UK in the transcatheter valve era

AU - Khawaja, Muhammed Z.

AU - Sohal, Manav

AU - Valli, Haseeb

AU - Dworakowski, Rafal

AU - Pettit, Stephen J.

AU - Roy, David

AU - Newton, James

AU - Schneider, Heiko

AU - Manoharan, Ganesh

AU - Doshi, Sagar

AU - Muir, Douglas

AU - Roberts, David

AU - Nolan, James

AU - Gunning, Mark

AU - Densem, Cameron

AU - Spence, Mark S.

AU - Chowdhary, Saqib

AU - Mahadevan, Vaikom S.

AU - Brecker, Stephen J.

AU - MacCarthy, Philip

AU - Mullen, Michael

AU - Stables, Rodney H.

AU - Prendergast, Bernard D.

AU - de Belder, Adam

AU - Thomas, Martyn

AU - Redwood, Simon

AU - Hildick-Smith, David

PY - 2013/2

Y1 - 2013/2

N2 - 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 centers across the UK were analyzed. 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 mm Hg. Aortic valve area increased from 0.58 +/- 0.19 to 0.80 +/- 0.25 cm2 echocardiographically. Procedural complication rate was 6.3%, comprising death (2.4%), blood transfusion 2 U (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 (HR 1.53, 95%CI 1.082.17, P = 0.018), poor LV function (HR 1.54, 95%CI 1.092.16, P = 0.014), and either urgent (HR 1.70, 95%CI 1.182.45; P = 0.004) or emergent presentation (HR 3.72, 95%CI 2.276.08; P <0.0001). Conclusion Balloon aortic valvuloplasty offers good immediate hemodynamic efficacy at an acceptable risk of major complications. Medium-term prognosis is poor in the absence of definitive therapy.

AB - 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 centers across the UK were analyzed. 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 mm Hg. Aortic valve area increased from 0.58 +/- 0.19 to 0.80 +/- 0.25 cm2 echocardiographically. Procedural complication rate was 6.3%, comprising death (2.4%), blood transfusion 2 U (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 (HR 1.53, 95%CI 1.082.17, P = 0.018), poor LV function (HR 1.54, 95%CI 1.092.16, P = 0.014), and either urgent (HR 1.70, 95%CI 1.182.45; P = 0.004) or emergent presentation (HR 3.72, 95%CI 2.276.08; P <0.0001). Conclusion Balloon aortic valvuloplasty offers good immediate hemodynamic efficacy at an acceptable risk of major complications. Medium-term prognosis is poor in the absence of definitive therapy.

KW - aortic stenosis

KW - balloon aortic valvuloplasty

KW - PERCUTANEOUS CORONARY INTERVENTION

KW - LONG-TERM SURVIVAL

KW - ELDERLY PATIENTS

KW - HIGH-RISK

KW - ARTERY-DISEASE

KW - BONE-FORMATION

KW - FOLLOW-UP

KW - STENOSIS

KW - IMPLANTATION

KW - REGISTRY

U2 - 10.1002/ccd.24534

DO - 10.1002/ccd.24534

M3 - Article

SN - 1522-1946

VL - 81

SP - 366

EP - 373

JO - CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS

JF - CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS

IS - 2

ER -

Standalone balloon aortic valvuloplasty: Indications and outcomes from the UK in the transcatheter valve era

Abstract

Keywords

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