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Dall'Ara G, Piciucchi S, Moretti C, Cavazza C, Compagnone M, Guerrieri G, Grotti S, Spartà D, Carletti R, Fabbri E, Giampalma E, Santarelli A, Ottani F, Balducelli M, Saia F, Tarantino FF, Galvani M. Aortic balloon valvuloplasty outcome according to calcium distribution and valve geometry - The ABCD study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00627-4. [PMID: 39164142 DOI: 10.1016/j.carrev.2024.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 08/02/2024] [Accepted: 08/14/2024] [Indexed: 08/22/2024]
Abstract
BACKGROUND There is little data on the outcome of balloon aortic valvuloplasty (BAV) in relation to valve dimensions and calcification patterns. The procedure is not standardized, particularly the choice of balloon size. METHODS This retrospective multicenter study focused on BAV efficacy and safety by analyzing the relationship between balloon size, annulus geometry (i.e., diameters, perimeter, and area), and calcification patterns (total burden and calcium distribution over each individual leaflet). From March 2018 to March 2023, all consecutive patients who underwent clinically indicated BAV and ECG-gated multidetector computed tomography of the aorta were included, except those with a bicuspid valve. Calcium score was calculated on contrast-enhanced images based on a luminal attenuation threshold of +100 HU. RESULTS One hundred and fifteen patients were included. Procedural success was 82.6 %. The balloon-to-annulus ratio (BAR) relative to diameter, perimeter, and area was higher in patients with successful BAV. Patients with unsuccessful BAV had a significantly higher aortic valve calcium burden. The complication rate was 4.3 % and there was no association with valve geometry or calcium burden. A trend towards a reduced complication rate was found as calcium asymmetry increased. BAR minimum annulus diameter was the best parameter in predicting procedural success, with a cut-off at 0.85. CONCLUSIONS BAV efficacy is correlated directly with balloon size in relation to annulus dimension and inversely with total calcium burden. The minimum diameter of the valve may be adopted as a reference for balloon sizing.
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Affiliation(s)
- Gianni Dall'Ara
- Cardiology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy.
| | - Sara Piciucchi
- Department of Radiology, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Carolina Moretti
- Cardiology Unit, Santa Maria delle Croci Hospital, Ravenna, Italy
| | | | | | | | - Simone Grotti
- Cardiology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Daniela Spartà
- Cardiology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | | | | | | | | | | | - Marco Balducelli
- Cardiology Unit, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Francesco Saia
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy
| | | | - Marcello Galvani
- Cardiology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy; Cardiovascular Research Unit, Myriam Zito Sacco Heart Foundation, Forlì, Italy
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Dall'Ara G, Grotti S, Guerrieri G, Compagnone M, Spartà D, Galvani M, Tarantino F. Balloon aortic valvuloplasty: current status and future prospects. Expert Rev Cardiovasc Ther 2022; 20:389-402. [PMID: 35514027 DOI: 10.1080/14779072.2022.2074837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Balloon aortic valvuloplasty (BAV) improves hemodynamic and clinical status of patients with severe aortic stenosis (AS) for a limited period of 6-12 months. However, there is a high number of procedures performed worldwide and an upward trend over the last decades. AREAS COVERED Epidemiology of AS and the advent of transcatheter aortic valve implantation (TAVI) contribute to the extensive referral of patients. The expansion of recommendations for TAVI has occasionally led to financial reimbursement-related problems that do not exist for BAV. BAV is indicated as a bridge to valve replacement, to decision in complex cases, and to extracardiac surgery. BAV may play a role in preparing for TAVI and optimizing procedural results. The minimalist approach and reduced complication rate make it applicable in fragile patients. EXPERT OPINION In the near future, BAV will continue to be a useful asset in managing patients with AS given the multiple indications, broad applicability, safety profile, low cost, and repeatability. Specific studies are necessary to explore technical solutions, stronger indications, the finest technique, and to standardize the procedural result. Pending the development of potential competitive devices, the role that BAV plays will remain closely intertwined with the one played by TAVI.
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Affiliation(s)
| | - Simone Grotti
- Cardiology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | | | | | - Daniela Spartà
- Cardiology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Marcello Galvani
- Cardiology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy.,Cardiovascular Research Unit, Myriam Zito Sacco Heart Foundation, Forlì, Italy
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Debry N, Altes A, Vincent F, Delhaye C, Schurtz G, Nedjari F, Legros G, Porouchani S, Coisne A, Richardson M, Cosenza A, Verdier B, Denimal T, Pamart T, Spillemaeker H, Sylla H, Sudre A, Janah D, Aouate D, Marsou W, Appert L, Lemesle G, Labreuche J, Maréchaux S, Van Belle E. Balloon aortic valvuloplasty for severe aortic stenosis before urgent non-cardiac surgery. EUROINTERVENTION 2021; 17:e680-e687. [PMID: 34105511 PMCID: PMC9724970 DOI: 10.4244/eij-d-20-01423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Balloon aortic valvuloplasty (BAV) has been proposed as a therapeutic option in patients suffering from severe aortic stenosis (SAS) who need urgent non-cardiac surgery (NCS). Whether this strategy is better than medical therapy in this very specific population is unknown. AIMS We aimed to evaluate the clinical benefit of an invasive strategy (IS) with preoperative BAV in patients with SAS requiring urgent NCS. METHODS From 2011 to 2019, a registry conducted in two centres included 133 patients with SAS undergoing urgent NCS, of whom 93 underwent preoperative BAV (IS) and 40 a conservative strategy (CS) without BAV. All analyses were adjusted for confounding using inverse probability of treatment weighting (IPTW) (10 clinical and anatomical variables). RESULTS The primary outcome was MACE at one-month follow-up after NCS including mortality, heart failure, and other cardiovascular outcomes. In patients managed conservatively, occurrence of MACE was 20.0% (n=8) and death was 10.0% (n=4) at 1 month. In patients undergoing BAV, the occurrence of MACE was 20.4% (n=19) and death was 5.4% (n=5) at 1 month. Among patients undergoing conservative management, all events were observed after NCS while, in patients undergoing BAV, 12.9% (n=12) had events between BAV and NCS including 3 deaths, and 7.5% (n=7) had events after NCS including 2 deaths. In IPTW propensity analyses, the incidence of the primary outcome (20.4% vs 20.0%; OR 0.93, 95% CI: 0.38-2.29) and three-month survival (89.2% vs 90.0%; IPTW-adjusted HR 0.90, 95% CI: 0.31-2.60) were similar in both groups. CONCLUSIONS Patients with SAS managed conservatively before urgent NCS are at high risk of events. A systematic invasive strategy using BAV does not provide a significant improvement in clinical outcome.
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Affiliation(s)
- Nicolas Debry
- CHU Lille, Institut Coeur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Lille, France,Groupement des Hôpitaux de l’Institut Catholique de Lille (GHICL), Cardiology Department and Heart Valve Centre, Faculté Libre de Médecine/Université Catholique de Lille, Lille, France,INSERM, U1011, Lille, France
| | - Alexandre Altes
- Groupement des Hôpitaux de l’Institut Catholique de Lille (GHICL), Cardiology Department and Heart Valve Centre, Faculté Libre de Médecine/Université Catholique de Lille, Lille, France
| | - Flavien Vincent
- CHU Lille, Institut Coeur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Lille, France,INSERM, U1011, Lille, France,Université de Lille, Lille, France
| | - Cédric Delhaye
- CHU Lille, Institut Coeur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Lille, France
| | - Guillaume Schurtz
- CHU Lille, Institut Coeur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Lille, France
| | - Farid Nedjari
- Groupement des Hôpitaux de l’Institut Catholique de Lille (GHICL), Cardiology Department and Heart Valve Centre, Faculté Libre de Médecine/Université Catholique de Lille, Lille, France
| | - Gabin Legros
- Groupement des Hôpitaux de l’Institut Catholique de Lille (GHICL), Cardiology Department and Heart Valve Centre, Faculté Libre de Médecine/Université Catholique de Lille, Lille, France
| | - Sina Porouchani
- CHU Lille, Institut Coeur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Lille, France
| | - Augustin Coisne
- INSERM, U1011, Lille, France,Université de Lille, Lille, France,CHU Lille, Department of Clinical Physiology and Echocardiography, Lille, France
| | - Marjorie Richardson
- CHU Lille, Department of Clinical Physiology and Echocardiography, Lille, France
| | - Alessandro Cosenza
- CHU Lille, Institut Coeur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Lille, France
| | - Basile Verdier
- CHU Lille, Institut Coeur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Lille, France
| | - Tom Denimal
- CHU Lille, Institut Coeur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Lille, France
| | - Thibault Pamart
- CHU Lille, Institut Coeur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Lille, France
| | - Hugues Spillemaeker
- CHU Lille, Institut Coeur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Lille, France
| | - Habib Sylla
- CHU Lille, Institut Coeur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Lille, France
| | - Arnaud Sudre
- CHU Lille, Institut Coeur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Lille, France
| | - Dany Janah
- CHU Lille, Institut Coeur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Lille, France
| | - David Aouate
- CHU Lille, Institut Coeur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Lille, France
| | - Wassima Marsou
- Groupement des Hôpitaux de l’Institut Catholique de Lille (GHICL), Cardiology Department and Heart Valve Centre, Faculté Libre de Médecine/Université Catholique de Lille, Lille, France
| | - Ludovic Appert
- Groupement des Hôpitaux de l’Institut Catholique de Lille (GHICL), Cardiology Department and Heart Valve Centre, Faculté Libre de Médecine/Université Catholique de Lille, Lille, France
| | - Gilles Lemesle
- CHU Lille, Institut Coeur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Lille, France,INSERM, U1011, Lille, France,Université de Lille, Lille, France
| | | | - Sylvestre Maréchaux
- Groupement des Hôpitaux de l’Institut Catholique de Lille (GHICL), Cardiology Department and Heart Valve Centre, Faculté Libre de Médecine/Université Catholique de Lille, Lille, France
| | - Eric Van Belle
- Cardiology Department, Institut Coeur-Poumons, CHU Lille, Boulevard du Professeur Jules Leclercq, 59000 Lille, France
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Ultrasound-Guided Percutaneous Balloon Aortic Valvuloplasty for Aortic Stenosis. J Interv Cardiol 2020; 2020:8086796. [PMID: 32256250 PMCID: PMC7102489 DOI: 10.1155/2020/8086796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 02/18/2020] [Indexed: 11/28/2022] Open
Abstract
Percutaneous balloon aortic valvuloplasty (PBAV), which is used to treat symptomatic aortic stenosis, requires ionizing radiation and contrast agent for imaging guidance. The aim of the study is to evaluate the feasibility and effectiveness of ultrasound-guided PBAV in patients with aortic stenosis. This case series included 30 patients (14 males; mean age, 61.5 ± 4.5 years) with moderate/severe aortic stenosis treated with ultrasound-guided PBAV at the Ultrasound Department, Fuwai Hospital, Beijing, China, between January 2016 and July 2019. Cardiac function (New York Heart Association grade) was assessed before PBAV and 1 month after the procedure. Aortic peak jet velocity, aortic valve orifice area (AVA), mean transvalvular pressure gradient (MTPG), left ventricular end-diastolic diameter (LVDD), left ventricular ejection fraction (LVEF), and left ventricular end-systolic diameter (LVESD) were determined before and immediately after PBAV using Doppler echocardiography. Preprocedural cardiac function was grade I in 3 cases, grade II in 9 cases, grade III in 10 cases, and grade IV in 8 cases. Postprocedural cardiac function was grade I in 22 cases, grade II in 4 cases, and grade III in 4 cases, suggesting that cardiac function was improved by PBAV. Ultrasound-guided PBAV resulted in significant improvements (P < 0.05) in aortic peak jet velocity (3.68 ± 0.811 m/s vs. 4.79 ± 0.63 m/s), MTPG (33.77 ± 13.85 mmHg vs. 54.54 ± 13.81 mmHg), AVA (1.96 ± 0.25 cm2 vs. 0.98 ± 0.12 cm2), LVEDD (51.90 ± 3.21 mm vs. 65.60 ± 6.81 mm), LVEF (63.46 ± 11.29% vs. 56.31 ± 11.04%), and LVESD (35.50 2.62 mm vs. 45.20 ± 2.42 mm). Ultrasound-guided PBAV is feasible and achieves good short-term effects in patients with aortic stenosis.
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