TY - JOUR
T1 - Effect of Balloon Aortic Valvuloplasty on Mortality in Patients With Severe Aortic Stenosis Prior to Conservative Treatment and Surgical or Transcatheter Aortic Valve Replacement
AU - Jones, Dylan R.
AU - Chew, Derek P.
AU - Horsfall, Matthew J.
AU - Chuang, Anthony M.
AU - Sinhal, Ajay R.
AU - Joseph, Majo X.
AU - Baker, Robert A.
AU - Bennetts, Jayme S.
AU - Selvanayagam, Joseph B.
AU - Lehman, Sam J.
PY - 2020/5
Y1 - 2020/5
N2 - Background: Outcomes following an initial strategy of balloon aortic valvuloplasty (BAV) prior to medical therapy or intervention with surgical or transcatheter aortic valve replacement (SAVR or TAVR) are unclear in the modern transcatheter intervention era.Methods: A retrospective, observational cohort study of the echocardiography, cardiothoracic surgery and TAVR databases between 1 January 2006 and 31 December 2016 was performed to compare outcomes between all patients with severe aortic stenosis (AS) treated with or without BAV prior to medical or invasive therapy. Results: 3,142 patients were available for analysis. 223 BAV treated patients had lower mortality relative to medically treated patients, particularly early (20.1% v. 7.6% at 6 months, 58.1% v. 52.5% at 5 years). Over 5 years, the adjusted hazard ratio (HR) was 0.62 (95% CI 0.48–0.80, p < 0.001). Compared with 630 patients proceeding directly to intervention, 75 patients receiving BAV experienced a higher mortality (HR = 2.76, 95% CI 2.07–3.66, p < 0.001). No subsequent excess perioperative mortality was observed with BAV compared with those receiving surgery directly (HR = 1.45, 95% CI 0.91–2.31, p = 0.117). Conclusions: The risk associated with BAV is low, and improves mortality compared with medical therapy. Balloon aortic valvuloplasty treated patients have poorer outcomes, but treatment with BAV does not increase perioperative mortality and may lessen it.
AB - Background: Outcomes following an initial strategy of balloon aortic valvuloplasty (BAV) prior to medical therapy or intervention with surgical or transcatheter aortic valve replacement (SAVR or TAVR) are unclear in the modern transcatheter intervention era.Methods: A retrospective, observational cohort study of the echocardiography, cardiothoracic surgery and TAVR databases between 1 January 2006 and 31 December 2016 was performed to compare outcomes between all patients with severe aortic stenosis (AS) treated with or without BAV prior to medical or invasive therapy. Results: 3,142 patients were available for analysis. 223 BAV treated patients had lower mortality relative to medically treated patients, particularly early (20.1% v. 7.6% at 6 months, 58.1% v. 52.5% at 5 years). Over 5 years, the adjusted hazard ratio (HR) was 0.62 (95% CI 0.48–0.80, p < 0.001). Compared with 630 patients proceeding directly to intervention, 75 patients receiving BAV experienced a higher mortality (HR = 2.76, 95% CI 2.07–3.66, p < 0.001). No subsequent excess perioperative mortality was observed with BAV compared with those receiving surgery directly (HR = 1.45, 95% CI 0.91–2.31, p = 0.117). Conclusions: The risk associated with BAV is low, and improves mortality compared with medical therapy. Balloon aortic valvuloplasty treated patients have poorer outcomes, but treatment with BAV does not increase perioperative mortality and may lessen it.
KW - Aortic stenosis (AS)
KW - Balloon aortic valvuloplasty (BAV)
KW - Surgical aortic valve replacement (SAVR)
KW - Transcatheter aortic valve replacement (TAVR)
UR - http://www.scopus.com/inward/record.url?scp=85068253429&partnerID=8YFLogxK
U2 - 10.1016/j.hlc.2019.06.717
DO - 10.1016/j.hlc.2019.06.717
M3 - Article
AN - SCOPUS:85068253429
SN - 1443-9506
VL - 29
SP - 719
EP - 728
JO - Heart, Lung and Circulation
JF - Heart, Lung and Circulation
IS - 5
ER -