Mohamad Alkhouli1, Chad J Zack1, Mohammad Sarraf1, Riyaz Bashir1, Rick A Nishimura1, Mackram F Eleid1, Vuyisile T Nkomo1, Gurpreet S Sandhu1, Rajiv Gulati1, Kevin L Greason1, David R Holmes1, Charanjit S Rihal2. 1. From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.). 2. From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.). Rihal@mayo.edu.
Abstract
BACKGROUND: The introduction of transcatheter aortic valve replacement (TAVR) led to renewed interest in balloon aortic valvuloplasty (BAV). We sought to assess contemporary trends in BAV utilization and their outcomes. METHODS AND RESULTS: The Nationwide Inpatient Sample was used to identify patients who underwent BAV between 2004 and 2013. In-hospital morbidity and mortality, and predictors of death after BAV were assessed. Outcomes of propensity-matched groups of patients undergoing elective BAV or TAVR were evaluated. BAV utilization increased from 707 cases in 2004 to 3715 cases in 2013 (national estimates). Procedural and in-hospital mortality were 1.4% and 8.5%, respectively. Vascular complications occurred in 7.0% of cases, blood transfusion in 17.5%, clinical stroke in 1.8%, and pacemaker implantation in 3.0%. The strongest predictors of in-hospital death were cardiogenic shock (odds ratio, 6.01; 95% confidence interval, 4.19-8.61; P<0.001), need for left ventricular assist device (odds ratio, 3.48; 95% confidence interval, 2.25-5.36; P<0.001), coagulopathy (odds ratio, 2.19; 95% confidence interval, 1.51-3.18; P<0.001), and low institutional volume of BAV (odds ratio, 1.58; 95% confidence interval, 1.06-2.37; P=0.03). In propensity-matched patients undergoing elective BAV or TAVR, rates of in-hospital mortality (2.9% versus 3.5%; P=0.60), clinical stroke (1.6% versus 3.1%; P=0.10), and vascular complications (8.2% versus 10.9%; P=0.14) were similar. However, BAV was associated with lower rates of pacemaker implantation (2.9% versus 8.0%; P<0.001) and blood transfusion (12.8% versus 22.9%; P<0.001). CONCLUSIONS: In a contemporary national registry, BAV is associated with significant morbidity and mortality that are similar to TAVR. With the substantial increase in BAV utilization and the continuous improvement in TAVR outcomes, these data have important implications to aid clinicians in the selection of appropriate BAV candidates.
BACKGROUND: The introduction of transcatheter aortic valve replacement (TAVR) led to renewed interest in balloon aortic valvuloplasty (BAV). We sought to assess contemporary trends in BAV utilization and their outcomes. METHODS AND RESULTS: The Nationwide Inpatient Sample was used to identify patients who underwent BAV between 2004 and 2013. In-hospital morbidity and mortality, and predictors of death after BAV were assessed. Outcomes of propensity-matched groups of patients undergoing elective BAV or TAVR were evaluated. BAV utilization increased from 707 cases in 2004 to 3715 cases in 2013 (national estimates). Procedural and in-hospital mortality were 1.4% and 8.5%, respectively. Vascular complications occurred in 7.0% of cases, blood transfusion in 17.5%, clinical stroke in 1.8%, and pacemaker implantation in 3.0%. The strongest predictors of in-hospital death were cardiogenic shock (odds ratio, 6.01; 95% confidence interval, 4.19-8.61; P<0.001), need for left ventricular assist device (odds ratio, 3.48; 95% confidence interval, 2.25-5.36; P<0.001), coagulopathy (odds ratio, 2.19; 95% confidence interval, 1.51-3.18; P<0.001), and low institutional volume of BAV (odds ratio, 1.58; 95% confidence interval, 1.06-2.37; P=0.03). In propensity-matched patients undergoing elective BAV or TAVR, rates of in-hospital mortality (2.9% versus 3.5%; P=0.60), clinical stroke (1.6% versus 3.1%; P=0.10), and vascular complications (8.2% versus 10.9%; P=0.14) were similar. However, BAV was associated with lower rates of pacemaker implantation (2.9% versus 8.0%; P<0.001) and blood transfusion (12.8% versus 22.9%; P<0.001). CONCLUSIONS: In a contemporary national registry, BAV is associated with significant morbidity and mortality that are similar to TAVR. With the substantial increase in BAV utilization and the continuous improvement in TAVR outcomes, these data have important implications to aid clinicians in the selection of appropriate BAV candidates.
Authors: Matteo Pagnesi; Luca Baldetti; Paolo Del Sole; Antonio Mangieri; Marco B Ancona; Damiano Regazzoli; Nicola Buzzatti; Francesco Giannini; Antonio Colombo; Azeem Latib Journal: Interv Cardiol Date: 2017-09
Authors: Anda Bularga; Rong Bing; Anoop Sv Shah; Philip D Adamson; Miles Behan; David E Newby; Andrew Flapan; Neal Uren; Nick Cruden Journal: Open Heart Date: 2020-09