Authors

• Željko Baričević — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-5420-2324
• Joško Bulum — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-1482-6503
• Maja Strozzi — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0003-4596-8261
• Boško Skorić — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0001-5979-2346
• Jadranka Šeparović — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
• Hanževački — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-3437-6407
• Davor Miličić — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0001-9101-1570

Keywords

balloon aortic valvuloplasty, aortic stenosis, transcatheter aortic valve implantation

DOI

Full Text

Balloon aortic valvuloplasty (BAV) may be used in high-risk patients with severe aortic stenosis and temporary contraindications to immediate intervention (1). It serves as a brief temporizing procedure with a poor long-term outcome (2); however, as a bridge therapy, it is associated with rapid clinical and/or functional improvement allowing eligibility of majority of these patients for definitive invasive treatment, including surgical aortic valve replacement or transcatheter aortic valve implantation (TAVI). TAVI has emerged as an excellent alternative treatment for poor surgical candidates and the number of BAV procedures is expected to increase in the near future. To our knowledge, BAV has been used sporadically in the past years in Croatia. As institutional practices and physician biases can affect patient selection and management approaches to severe aortic stenosis, it is important to have the facility that can offer BAV (especially in the TAVI era) as another management option for patients who would otherwise have been considered unacceptably high risk for aortic valve intervention. We present a short overview of our one-year experience upon systematic BAV reinstitution, following the development of a TAVI programme in University Hospital Centre Zagreb. The classic retrograde technique using 11 F femoral arterial sheath, transvenous temporary cardiac pacing and left transradial approach for ascending aorta pressure monitoring was used. The results of the procedures conducted on 13 patients (7 male, 6 female) between 51 and 90 years of age (78 years on average) and mean left ventricular ejection fraction 30% were very promising. The mean aortic valve area increased from 0.61 ± 0.17 cm2 to 0.83 ± 0.24 cm with an acute drop of the mean transaortic gradient from 37 ±18 mmHg to 26 ±13 mmHg. Among serious adverse events there were no cases of intraprocedural death, stroke, coronary occlusion, severe aortic regurgitation, tamponade or need for permanent pacemaker. Vascular complication occured in 1 patient (non-occlusive femoral artery dissection) and resuscitation/cardioversion was done in 1 patient. 30-day mortality was 15,4%.

Literature

1. Ben-Dor I, Pichard AD, Satler LF, Goldstein SA, Syed AI, Gaglia MA, et al. Complications and outcome of balloon aortic valvuloplasty in high-risk or inoperable patients. JACC Cardiovasc Interv. 2010;3(11):1150–6. https://doi.org/10.1016/j.jcin.2010.08.014
2. Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC), European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, et al. Guidelines on the management of valvular heart disease (version 2012): The Joint Task Force on the Management of Valvular Heart Disease of the ESC and the EACTS. Eur Heart J. 2012;33(19):2451–96. https://doi.org/10.1093/eurheartj/ehs109