Outcomes of balloon aortic valvuloplasty in contemporary practice: A single-center observational study

BACKGROUND: Balloon aortic valvuloplasty (BAV) remains a vital tool as a bridge to definitive treatment, a palliative therapy, or a stabilizing procedure for hemodynamically unstable patients. AIMS: Our aim was to characterize patients undergoing BAV and identify predictors of procedural success, major adverse cardiovascular and cerebrovascular events, and in-hospital mortality. METHODS: This retrospective, single-center registry embraced consecutive patients undergoing BAV between 2010 and 2022. Procedural success was defined as mean pressure gradient reduction > 10 mm Hg. Major adverse cardiovascular and cerebrovascular events was the primary composite endpoint. RESULTS: Among 136 patients (57 men [41.9%]; mean [standard deviation] age 78.5 [8.9] years), BAV was performed as: a bridge to transcatheter aortic valve implantation (n = 42, 30.9%), palliative procedure (n = 49, 36.0%), prognostic procedure during transcatheter aortic valve implantation qualification (n = 33, 24.3%). Sixteen patients underwent percutaneous coronary intervention (14 before [10.3%] and 2 during BAV [1.5%]). Procedural success was reported in 60 patients (44.1%) and independently associated with a higher mean pressure gradient (odds ratio [OR], 1.09; 95% confidence interval: 1.002-1.19; P = 0.04). Major adverse cardiovascular and cerebrovascular events occurred in 23 patients (16.9%), was independently predicted by a higher maximal aortic valve gradient (OR, 1.02; P = 0.014) and need for intubation (OR, 15.5; P = 0.003). In-hospital mortality was 6.6%, with precedent percutaneous coronary intervention being its independent predictor (OR, 32.0; P = 0.015). Patients after successful BAV more frequently underwent subsequent aortic valve replacement. CONCLUSIONS: Balloon aortic valvuloplasty remains a valuable procedure, particularly as a bridge to definitive treatment. Major adverse cardiovascular and cerebrovascular events and mortality risk remains significant, highlighting the fragile nature of the patients' population.