Journal Article

Balloon aortic valvuloplasty as a bridge to aortic valve surgery for severe aortic stenosis

Nnamdi Nwaejike, Keith Mills, Rod Stables and Mark Field

in Interactive CardioVascular and Thoracic Surgery

Volume 20, issue 3, pages 429-435
Published in print March 2015 | ISSN: 1569-9293
Published online December 2014 | e-ISSN: 1569-9285 | DOI: https://dx.doi.org/10.1093/icvts/ivu398
Balloon aortic valvuloplasty as a bridge to aortic valve surgery for severe aortic stenosis

More Like This

Show all results sharing these subjects:

  • Cardiovascular Medicine
  • Transplant Surgery
  • Research Methods in Life Sciences

GO

Show Summary Details

Preview

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, in patients with severe aortic stenosis, can balloon valvuloplasty be used as a bridge to aortic valve replacement? Altogether 463 papers were found using the reported search, of which 11 papers represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that balloon aortic valvuloplasty is recommended as a bridge to aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI) in patients with severe symptomatic aortic stenosis. Institutional practices, local and logistic factors can affect patient selection and management approaches to severe aortic stenosis, but having the facility to offer balloon aortic valvuloplasty (especially in the TAVI era) provides another management option for patients who would otherwise have been considered unacceptably high risk for aortic valve surgery. The increased incidence of balloon aortic valvuloplasty mirrors the increase in the use of TAVI with a sharp increase in activity from 2006. Success rates for bridging from balloon aortic valvuloplasty to definite surgical intervention are in the range 26.3–74%, with AVR or TAVI occurring within 8 weeks to 7 months. Complications from balloon aortic valvuloplasty such as aortic regurgitation (AR) can be managed successfully. Up to 40% of patients selected by balloon aortic valvuloplasty to have TAVI or AVR do not have these procedures within 2 years. While most of these patients are excluded for objective clinical reasons such as terminal disease/malignancy or other persistent contraindication, some patients refuse definitive treatment and others die while on the waiting list. Outcomes in patients bridged to AVR/TAVI are better than in patients treated with balloon aortic valvuloplasty only. Owing to the high mortality of patients in this cohort without destination therapy, delays to progression to TAVI or AVR should be avoided in selected patients. A discussion with the patient about expectations, mortality and morbidity risks with all management options will aid decision-making.

Keywords: Aortic stenosis; Bridge to aortic valve replacement; Bridge to transcatheter aortic valve implantation

Journal Article.  3953 words. 

Subjects: Cardiovascular Medicine ; Transplant Surgery ; Research Methods in Life Sciences

Full text: subscription required

How to subscribe Recommend to my Librarian

Users without a subscription are not able to see the full content. Please, subscribe or login to access all content. subscribe or login to access all content.