Cargando…
Balloon aortic valvuloplasty as a bridge-to-decision in high risk patients with aortic stenosis: a new paradigm for the heart team decision making
BACKGROUND: Whilst the majority of the patients with severe aortic stenosis can be directly addressed to surgical aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI), in some instances additional information may be needed to complete the diagnostic workout. We evaluated...
Autores principales: | , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Science Press
2016
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4987415/ https://www.ncbi.nlm.nih.gov/pubmed/27582761 http://dx.doi.org/10.11909/j.issn.1671-5411.2016.06.002 |
_version_ | 1782448301349535744 |
---|---|
author | Saia, Francesco Moretti, Carolina Dall'Ara, Gianni Ciuca, Cristina Taglieri, Nevio Berardini, Alessandra Gallo, Pamela Cannizzo, Marina Chiarabelli, Matteo Ramponi, Niccolò Taffani, Linda Bacchi-Reggiani, Maria Letizia Marrozzini, Cinzia Rapezzi, Claudio Marzocchi, Antonio |
author_facet | Saia, Francesco Moretti, Carolina Dall'Ara, Gianni Ciuca, Cristina Taglieri, Nevio Berardini, Alessandra Gallo, Pamela Cannizzo, Marina Chiarabelli, Matteo Ramponi, Niccolò Taffani, Linda Bacchi-Reggiani, Maria Letizia Marrozzini, Cinzia Rapezzi, Claudio Marzocchi, Antonio |
author_sort | Saia, Francesco |
collection | PubMed |
description | BACKGROUND: Whilst the majority of the patients with severe aortic stenosis can be directly addressed to surgical aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI), in some instances additional information may be needed to complete the diagnostic workout. We evaluated the role of balloon aortic valvuloplasty (BAV) as a bridge-to-decision (BTD) in selected high-risk patients. METHODS: Between 2007 and 2012, the heart team in our Institution required BTD BAV in 202 patients. Very low left ventricular ejection fraction, mitral regurgitation grade ≥ 3, frailty, hemodynamic instability, serious comorbidity, or a combination of these factors were the main drivers for this strategy. We evaluated how BAV influenced the final treatment strategy in the whole patient group and in each specific subgroup. RESULTS: Mean logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 23.5% ± 15.3%, age 81 ± 7 years. In-hospital mortality was 4.5%, cerebrovascular accident 1% and overall vascular complications 4% (0.5% major; 3.5% minor). Of the 193 patients with BTD BAV who survived and received a second heart team evaluation, 72.6% were finally deemed eligible for definitive treatment (25.4% for AVR; 47.2% for TAVI): 96.7% of patients with left ventricular ejection fraction recovery; 70.5% of patients with mitral regurgitation reduction; 75.7% of patients who underwent BAV in clinical hemodynamic instability; 69.2% of frail patients and 68% of patients who presented serious comorbidities. CONCLUSIONS: Balloon aortic valvuloplasty can be considered as bridge-to-decision in high-risk patients with severe aortic stenosis who cannot be immediate candidates for definitive transcatheter or surgical treatment. |
format | Online Article Text |
id | pubmed-4987415 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Science Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-49874152016-09-01 Balloon aortic valvuloplasty as a bridge-to-decision in high risk patients with aortic stenosis: a new paradigm for the heart team decision making Saia, Francesco Moretti, Carolina Dall'Ara, Gianni Ciuca, Cristina Taglieri, Nevio Berardini, Alessandra Gallo, Pamela Cannizzo, Marina Chiarabelli, Matteo Ramponi, Niccolò Taffani, Linda Bacchi-Reggiani, Maria Letizia Marrozzini, Cinzia Rapezzi, Claudio Marzocchi, Antonio J Geriatr Cardiol Symposium: Transcatheter aortic valve implantation BACKGROUND: Whilst the majority of the patients with severe aortic stenosis can be directly addressed to surgical aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI), in some instances additional information may be needed to complete the diagnostic workout. We evaluated the role of balloon aortic valvuloplasty (BAV) as a bridge-to-decision (BTD) in selected high-risk patients. METHODS: Between 2007 and 2012, the heart team in our Institution required BTD BAV in 202 patients. Very low left ventricular ejection fraction, mitral regurgitation grade ≥ 3, frailty, hemodynamic instability, serious comorbidity, or a combination of these factors were the main drivers for this strategy. We evaluated how BAV influenced the final treatment strategy in the whole patient group and in each specific subgroup. RESULTS: Mean logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 23.5% ± 15.3%, age 81 ± 7 years. In-hospital mortality was 4.5%, cerebrovascular accident 1% and overall vascular complications 4% (0.5% major; 3.5% minor). Of the 193 patients with BTD BAV who survived and received a second heart team evaluation, 72.6% were finally deemed eligible for definitive treatment (25.4% for AVR; 47.2% for TAVI): 96.7% of patients with left ventricular ejection fraction recovery; 70.5% of patients with mitral regurgitation reduction; 75.7% of patients who underwent BAV in clinical hemodynamic instability; 69.2% of frail patients and 68% of patients who presented serious comorbidities. CONCLUSIONS: Balloon aortic valvuloplasty can be considered as bridge-to-decision in high-risk patients with severe aortic stenosis who cannot be immediate candidates for definitive transcatheter or surgical treatment. Science Press 2016-09 /pmc/articles/PMC4987415/ /pubmed/27582761 http://dx.doi.org/10.11909/j.issn.1671-5411.2016.06.002 Text en Institute of Geriatric Cardiology http://creativecommons.org/licenses/by-nc-sa/3.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License, which allows readers to alter, transform, or build upon the article and then distribute the resulting work under the same or similar license to this one. The work must be attributed back to the original author and commercial use is not permitted without specific permission. |
spellingShingle | Symposium: Transcatheter aortic valve implantation Saia, Francesco Moretti, Carolina Dall'Ara, Gianni Ciuca, Cristina Taglieri, Nevio Berardini, Alessandra Gallo, Pamela Cannizzo, Marina Chiarabelli, Matteo Ramponi, Niccolò Taffani, Linda Bacchi-Reggiani, Maria Letizia Marrozzini, Cinzia Rapezzi, Claudio Marzocchi, Antonio Balloon aortic valvuloplasty as a bridge-to-decision in high risk patients with aortic stenosis: a new paradigm for the heart team decision making |
title | Balloon aortic valvuloplasty as a bridge-to-decision in high risk patients with aortic stenosis: a new paradigm for the heart team decision making |
title_full | Balloon aortic valvuloplasty as a bridge-to-decision in high risk patients with aortic stenosis: a new paradigm for the heart team decision making |
title_fullStr | Balloon aortic valvuloplasty as a bridge-to-decision in high risk patients with aortic stenosis: a new paradigm for the heart team decision making |
title_full_unstemmed | Balloon aortic valvuloplasty as a bridge-to-decision in high risk patients with aortic stenosis: a new paradigm for the heart team decision making |
title_short | Balloon aortic valvuloplasty as a bridge-to-decision in high risk patients with aortic stenosis: a new paradigm for the heart team decision making |
title_sort | balloon aortic valvuloplasty as a bridge-to-decision in high risk patients with aortic stenosis: a new paradigm for the heart team decision making |
topic | Symposium: Transcatheter aortic valve implantation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4987415/ https://www.ncbi.nlm.nih.gov/pubmed/27582761 http://dx.doi.org/10.11909/j.issn.1671-5411.2016.06.002 |
work_keys_str_mv | AT saiafrancesco balloonaorticvalvuloplastyasabridgetodecisioninhighriskpatientswithaorticstenosisanewparadigmfortheheartteamdecisionmaking AT moretticarolina balloonaorticvalvuloplastyasabridgetodecisioninhighriskpatientswithaorticstenosisanewparadigmfortheheartteamdecisionmaking AT dallaragianni balloonaorticvalvuloplastyasabridgetodecisioninhighriskpatientswithaorticstenosisanewparadigmfortheheartteamdecisionmaking AT ciucacristina balloonaorticvalvuloplastyasabridgetodecisioninhighriskpatientswithaorticstenosisanewparadigmfortheheartteamdecisionmaking AT taglierinevio balloonaorticvalvuloplastyasabridgetodecisioninhighriskpatientswithaorticstenosisanewparadigmfortheheartteamdecisionmaking AT berardinialessandra balloonaorticvalvuloplastyasabridgetodecisioninhighriskpatientswithaorticstenosisanewparadigmfortheheartteamdecisionmaking AT gallopamela balloonaorticvalvuloplastyasabridgetodecisioninhighriskpatientswithaorticstenosisanewparadigmfortheheartteamdecisionmaking AT cannizzomarina balloonaorticvalvuloplastyasabridgetodecisioninhighriskpatientswithaorticstenosisanewparadigmfortheheartteamdecisionmaking AT chiarabellimatteo balloonaorticvalvuloplastyasabridgetodecisioninhighriskpatientswithaorticstenosisanewparadigmfortheheartteamdecisionmaking AT ramponiniccolo balloonaorticvalvuloplastyasabridgetodecisioninhighriskpatientswithaorticstenosisanewparadigmfortheheartteamdecisionmaking AT taffanilinda balloonaorticvalvuloplastyasabridgetodecisioninhighriskpatientswithaorticstenosisanewparadigmfortheheartteamdecisionmaking AT bacchireggianimarialetizia balloonaorticvalvuloplastyasabridgetodecisioninhighriskpatientswithaorticstenosisanewparadigmfortheheartteamdecisionmaking AT marrozzinicinzia balloonaorticvalvuloplastyasabridgetodecisioninhighriskpatientswithaorticstenosisanewparadigmfortheheartteamdecisionmaking AT rapezziclaudio balloonaorticvalvuloplastyasabridgetodecisioninhighriskpatientswithaorticstenosisanewparadigmfortheheartteamdecisionmaking AT marzocchiantonio balloonaorticvalvuloplastyasabridgetodecisioninhighriskpatientswithaorticstenosisanewparadigmfortheheartteamdecisionmaking |