Current results of balloon aortic valvuloplasty in high-risk patients.

In this report, we describe our experience with a contemporary series of patients with severe aortic stenosis (AS) undergoing balloon aortic valvuloplasty (BAV) who were not deemed to be surgical candidates. Demographic, hemodynamic and procedural data, operative risk (EuroSCORE) and long-term follow up were collected. Eighty consecutive patients with severe symptomatic AS underwent 104 BAV procedures as a single center and were followed for a mean of 3+/-2 years. Thirteen patients underwent 2 BAV procedures, 2 patients underwent 3 BAV procedures and 1 patient underwent 5 BAV procedures. Mean age was 81+/-10 years, and 23% were >90 years of age. Cardiogenic shock was present in 20% and the ejection fraction was <30% in 38% of the patients. The mean EuroSCORE was 16+/-5, and 98% had a high-risk EuroSCORE. There were no procedural deaths and 9 (9%) total vascular complications. In-hospital, 1-, 2- and 3-year mortality rates were 6%, 44%, 62% and 71%, respectively. Seventeen patients (21%) underwent repeat BAV procedures and had long-term mortality similar to those undergoing a single BAV procedure. Contemporary BAV has acceptable short- and long-term results and can effectively be used for patients deemed unsuitable surgical candidates and those at highest operative risk, such as patients with cardiogenic shock.